Publications by authors named "Javad Sarrafzadeh"

41 Publications

Intrarater reliability of musculoskeletal ultrasound imaging of psoas major muscle in patients with subacute low back pain and healthy controls.

Med J Islam Repub Iran 2020 28;34:145. Epub 2020 Oct 28.

Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences and Health Services, Tehran, Iran.

Psoas major (PM) is a challenging muscle from the functional and anatomical point of view. The dysfunction of this muscle can result in low back pain (LBP). This study aimed to assess the intrarater reliability of ultrasound imaging (USI) of PM muscle thickness in subacute LBP patients and healthy participants without LBP in rest and during muscle contraction conditions. PM thickness was measured in all lumbar segments (L1-L5) using a USI device in 10 healthy and 10 subacute LBP participants. The intrarater data were assessed on the same day with 1- hour interval and after 7 days. Intraclass correlation coefficients (ICC), standard error of measurement (SEM), minimal detectable change (MDC), and independent t test were used for analyses. Significant level was set at 0.05. PM thickness in all lumbar levels had excellent reliability (ICC range 80-98) for both groups and conditions. SEM (0.42- 2.29) and MDC (1.16-6.34) were low, and PM thickness was greater than rest in contraction condition. There were no significant differences between the 2 groups in PM thickness. The USI demonstrated good intrarater reliability for assessing PM thickness in patients with subacute LBP. The thickness of PM in patients with subacute LBP was similar with that in healthy participants.
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http://dx.doi.org/10.47176/mjiri.34.145DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787047PMC
October 2020

Randomized Study of the Effects of Vitamin D and Magnesium Co-Supplementation on Muscle Strength and Function, Body Composition, and Inflammation in Vitamin D-Deficient Middle-Aged Women.

Biol Trace Elem Res 2020 Sep 21. Epub 2020 Sep 21.

Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.

This study aimed to investigate the effects of vitamin D and magnesium co-supplementation on muscle strength and function, body composition, and inflammation in vitamin D-deficient middle-aged women. In this study, 83 healthy middle-aged women (40-55 years) with vitamin D deficiency were randomly assigned into two groups: (1) intervention: receiving a 50,000-IU vitamin D soft gel (weekly) plus a 250-mg magnesium tablet (daily); (2) control: receiving a vitamin D placebo (weekly) plus a magnesium placebo (daily), for 8 weeks. Before and after the intervention, anthropometric indices, muscle strength, muscle function, and some inflammatory markers were measured. After 8 weeks of supplementation, significant difference was observed in handgrip strength and time for Time Get Up and Go (TGUG) test between the intervention and placebo groups (P < 0.05). Regarding percentage of fat mass (FM%) and fat free mass (FFM%), and knee extension strength, there was no significant difference between the two groups at the end of intervention (P > .05). Serum 25(OH)-D levels increased significantly (P < 0.001) and its change was significantly different between the two groups, at the end of the intervention (P < 0.001). Serum level of hs-CRP decreased significantly in the intervention group compared to baseline (P < 0.001), and the change in hs-CRP was significant between the two groups at the end of the intervention (P < 0.01). Furthermore, serum level of TNF-α declined significantly in the intervention group compared to baseline (P < 0.001) but, no significant differences were seen between the two groups in regard of serum levels of TNF-α and IL-6 after the intervention (P > 0.05). Our findings show that vitamin D and magnesium co-supplementation, for 8 weeks, in healthy middle-aged women with vitamin D deficiency have beneficial impacts on muscle strength, muscle function, and probably inflammation.
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http://dx.doi.org/10.1007/s12011-020-02387-2DOI Listing
September 2020

Gait analysis of patients with piriformis muscle syndrome compared to healthy controls.

Musculoskelet Sci Pract 2020 08 5;48:102165. Epub 2020 May 5.

Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.

Background: Piriformis muscle syndrome (PMS) is a condition that can causes local buttock pain and tenderness. The symptoms of PMS are related to the hip joint position and may affect repetitive daily tasks such as walking.

Objectives: What is the difference between the gait characteristics of patients with PMS and those of matched-healthy controls?

Design: Observational study.

Methods: Thirty patients with PMS and 30 age-, sex-, and height-matched healthy participants underwent three-dimensional walking analysis.

Results: The results showed no significant differences in the spatiotemporal characteristics of gait between the groups (p > 0.1). The PMS group flexed the hip joint significantly more (-7.2 [-11.9 to -2.2], p = 0.003) and extended the hip joint to a lesser degree (-2.48 [-4.91 to -0.5], p = 0.04) than the control group. Patients with PMS needed a statistically significantly longer time to reach the peak angles of hip internal (1.3 [1 to 1.9], p = 0.003) and external (5.5 [0.9 to 10.1], p = 0.01) rotations during the gait cycle. Further, the results showed that the sagittal range of motion of the knee joint was significantly lesser in patients with PMS than in controls (3.45 [0.4 to 6.4], p = 0.02).

Conclusions: Patients with PMS seem to have different kinematic changes during level walking. Changing the peak flexion and extension of the hip joint is considered a strategy to enable pain-free gait in patients with PMS. Further, the knee kinematics are modified consequent to the change of hip joint kinematics.
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http://dx.doi.org/10.1016/j.msksp.2020.102165DOI Listing
August 2020

Effect of a Spinomed orthosis on balance performance, spinal alignment, joint position sense and back muscle endurance in elderly people with hyperkyphotic posture: A randomized controlled trial.

Prosthet Orthot Int 2020 Aug 7;44(4):234-244. Epub 2020 Jun 7.

Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.

Background: Hyperkyphosis may cause balance impairment in elderly people. Although the effectiveness of orthoses for improving balance in hyperkyphotic elderly people has received much attention, the mechanisms by which devices affect balance remain unknown.

Objectives: The objective of this study was to evaluate changes in balance performance, thoracic kyphosis angle, craniovertebral angle, back muscle endurance and joint position sense after 3 months of wearing a Spinomed orthosis. The study also included a secondary exploratory analysis to determine whether changes in any of the above-mentioned outcome measures can predict balance performance improvement in elderly people with hyperkyphosis.

Study Design: Parallel group randomized controlled trial.

Methods: In total, 44 hyperkyphotic elderly people were randomly allocated to an experimental group, who wore a Spinomed orthosis and a control group, who did not. No other treatment or change in physical activity was permitted during the study. A blinded assessor evaluated thoracic kyphosis angle, joint position sense, craniovertebral angle, back muscle endurance, Timed Up and Go Test time and Berg Balance Scale score at baseline and after 5, 9 and 13 weeks. All dependent variables were measured without the orthosis and analyzed separately using a 2 × 4 (time × group) mixed model analysis of variance. Based on the results of correlation analysis, thoracic kyphosis angle, back muscle endurance and joint position sense were selected as independent variables in a stepwise multiple regression model.

Results: The two-way (group × time) interactions were significant in terms of Berg Balance Scale ( = 11.6,  ⩽ 0.001, ), Timed Up and Go Test ( = 3.74,  = 0.013, ), thoracic kyphosis angle ( = 43.39,  ⩽ 0.001, ), craniovertebral angle ( = 5.245,  = 0.002, ) and joint position sense ( = 4.44,  = 0.005, ). The two-way interaction was not significant in terms of back muscle endurance; however, the main effect of group was significant for this variable ( = 3.85,  = 0.025). Stepwise multiple regression showed that thoracic kyphosis angle and joint position sense were significant determinants of Timed Up and Go Test time ( = 0.155,  = 0.037 and  = 0.292,  = 0.012, respectively).

Conclusion: Wearing a Spinomed orthosis for 3 months improved the posture, position sense and muscle performance of hyperkyphotic elderly people. Orthoses may improve balance performance by correcting spinal alignment and increasing proprioceptive information.
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http://dx.doi.org/10.1177/0309364620923816DOI Listing
August 2020

Effect of Chronic Low Back Pain on Lumbar Spine Lordosis During Sit-to-Stand and Stand-to-Sit.

J Manipulative Physiol Ther 2020 02 30;43(2):79-92. Epub 2020 May 30.

Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Tehran, Iran.

Objective: This study aimed to evaluate lumbar lordosis during sit-to-stand (STS) and stand-to-sit (SIT) in individuals with and without chronic nonspecific low back pain (CNLBP). The second objective was to investigate sex-related differences in lumbar lordosis.

Methods: Twenty-six patients with CNLBP and 26 controls were recruited. Controls were matched with cases using a frequency matching method. Reflective markers were placed over the spinous process of T, L, S, and the anterior and posterior superior iliac spines. The participants were instructed to stand up at a self-selected pace and maintain their normal upright standing posture for 3 seconds, and then sit down. Kinematic data were recorded at a sampling frequency of 100 Hz using a motion capture system. Lumbar lordosis angle was calculated from the intersection between the line joining T and L, and the line joining L to S.

Results: Lumbar lordosis was decreased in patients with CNLBP during STS and SIT compared with the asymptomatic group (mean difference = 2.68°-9.32°; P ≤ .005). Furthermore, no differences were seen in lumbar lordosis at starting position between CNLBP and asymptomatic groups during STS and SIT (mean difference = 2.68°-3.75°; P ≥ .099). Interestingly, the magnitude of the effect size suggested that the difference in lumbar lordosis values between female and male participants was relatively large (Cohen's d = -1.81 to 0.20).

Conclusion: Decreased lumbar lordosis in patients with CNLBP during STS and SIT could be considered as an important point during rehabilitation. Moreover, the present study showed that there is a sex-related difference among women and men in lumbar lordosis during STS and SIT tasks.
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http://dx.doi.org/10.1016/j.jmpt.2018.11.028DOI Listing
February 2020

Comparative study of muscle energy technique, craniosacral therapy, and sensorimotor training effects on postural control in patients with nonspecific chronic low back pain.

J Family Med Prim Care 2020 Feb 28;9(2):978-984. Epub 2020 Feb 28.

Department of Health Psychology, University of Leuven, Leuven, Belgium.

Background: Malalignment in the pelvic and spinal column disturbs the balance and decreases the postural control ability. Malalignment is known as one of the main causes of back pain particularly the nonspecific chronic low back pain (NSCLBP). The aim of the study is to compare the effect of muscle energy technique (MET), craniosacral therapy (CST), and sensorimotor training (SMT) on postural control in patients with NSCLBP.

Materials And Methods: In this randomized clinical trial study, 45 NSCLBP patients were accidentally allocated in three groups including CST ( = 15), MET ( = 15), and SMT ( = 15). Clinical interventions including CST, MET, and SMT were performed in 10 sessions in 5 weeks (2 sessions per week). The parameters of center of pressure (COP) were assessed in 8 positions such as standing position on double or single leg with open or closed eyes or half squat position on double or single leg with open or closed eyes.

Results: The results of this study showed that all three methods of CST, MET, and SMT are effective in postural control in patients with NSCLBP, although it seems that CST is effective on more balance factors. CST has a greater effect on balance in standing position on a single leg with closed eye. It was also found that the effect of CST was continuous after follow-up.

Conclusion: Moreover, MET and SMT methods were effective in balance control in NSCLBP patients and postural control was more affected by CST.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_849_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7113991PMC
February 2020

The effect of soft tissue manipulation and rest on knee extensor muscles fatigue: Do torque parameters and induced perception following muscle fatigue have enough reliability?

J Family Med Prim Care 2020 Feb 28;9(2):950-956. Epub 2020 Feb 28.

Department of Physiotherapy, School of Rehabilitation, Iran University of Medical Sciences, Tehran, Iran.

Background: Muscle fatigue affects the precision of the subjects' performance and limits the range of physical and sports activities. There is limited scientific evidence to support the use of soft tissue manipulation for enhancing muscle performance and its recovery. The aim of this study is to compare the effects of soft tissue manipulation and rest on the knee extensor muscle fatigue after maximal isokinetic contractions.

Methods: Fifteen healthy females 20-30 years of age were selected for this research. This study implemented a semi-experimental test-retest measurement method. The subjects then either rested or received soft tissue manipulation on the knee extensors for a duration of 15 min. After intervention (soft tissue manipulation or rest), the parameters were evaluated for the third time.

Results: The stability of the average of peak torque (APT), average power (AP), and visual analog scale (VAS) before performing fatigue protocol was 85%, 83%, and 31.9%, respectively. The stability after fatigue was 43%, 50%, and 93%, respectively. After maximal fatigue and a decrease in torque output to below 50% maximal torque, 15 min of soft tissue manipulation could change the APT after fatigue from a mean of 58.3 (nm) to 91.5 (nm), the AP from 39.4 to 63.6 (nm/s), and the VAS, from 90.0 to 12 (mm). But 15 min of rest could change the APT from 52.5 to 68.1 (nm), the AP from 37.6 to 48 (nm/s), and the VAS from 90.0 to 27.3 (mm).

Conclusion: The study showed that soft tissue manipulation was more effective than rest as a strategy to return muscles to a normal state and caused more relief in perceived fatigue.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_838_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7114034PMC
February 2020

Pressure Pain Threshold in Subjects With Piriformis Syndrome: Test-Retest, Intrarater, and Interrater Reliability, and Minimal Detectible Changes.

Arch Phys Med Rehabil 2020 05 7;101(5):781-788. Epub 2019 Dec 7.

Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.

Objective: This study aimed to assess the test-retest, intrarater, and interrater reliability of using the pressure pain threshold (PPT) in healthy and affected piriformis muscles and to estimate its absolute reliability. As a secondary objective, the degree of tenderness of the affected piriformis muscles was compared with healthy piriformis muscles.

Study Design: This study used a comparative and reliability-based design.

Setting: Rehabilitation clinic.

Participants: Patients (N=30) with unilateral piriformis muscle syndrome (30 affected and 30 healthy piriformis muscles) were recruited, and the PPT of both the healthy and affected piriformis muscles was recorded using digital algometry. Measurements of PPT were done by 2 raters (rater 1 and 2), which were selected at random order. Rater 1 repeated the PPT measurements 24-72 hours after initial assessment.

Interventions: Not applicable.

Main Outcome Measure: PPT.

Results: Excellent intrarater intraclass correlation coefficient (ICC) values were observed for the PPT of the affected piriformis (ICC: 0.86-0.96) and the healthy piriformis (ICC: 0.88-0.96) in the same session. The PPT measurements using digital algometry showed good-to-excellent interrater reliability (ICC: 0.64-0.92) and test-retest reliability (ICC: 0.72-0.95) in both the healthy and affected piriformis muscles. The findings revealed a significant decrease in the PPT of the affected piriformis muscle in comparison to the healthy piriformis muscle (mean difference 12.76; 95% confidence interval, 15.69-9.82; P<.001).

Conclusions: Digital algometry is a reliable tool for measuring piriformis PPT, regardless of the testing session and the rater. Patients with unilateral piriformis muscle syndrome have increased tenderness and decreased PPT in the affected piriformis muscle in comparison to the healthy piriformis muscle.
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http://dx.doi.org/10.1016/j.apmr.2019.10.194DOI Listing
May 2020

The pulsed ultrasound strategy effectively decreases the S. aureus population of chronic rhinosinusitis patients.

BMC Res Notes 2019 Sep 13;12(1):576. Epub 2019 Sep 13.

Department of Medical Microbiology, School of Medicine, Tehran University of Medical Sciences, Poursina Street, Enghelabe-Eslami Avenue, Tehran, Iran.

Objective: Staphylococcus aureus with the ability of biofilm formation and the drug resistance acquisition is one of the most frequently isolated pathogens from chronic rhinosinusitis patients. Ultrasound as an alternative therapy is effectively able to kill the bacteria by cavitation in or on the bacterial cells and peroxide generation and hence improving antibiotic treatment efficacy.

Results: Staphylococcus aureus was detected in 4 and 6 out of 14 patients by phenotypic and qPCR assays, respectively. Four patients were completely resolved after pulsed ultrasound treatment. However, presence of the S. aureus was confirmed in three healthy controls by bacterial cultivation. Pulsed ultrasound have been quantitatively decreased the S. aureus population in chronic rhinosinusitis patients (p < 0.05). Further studies need to be investigated the effectiveness of pulsed ultrasound as an alternative course of CRS patient's treatment.
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http://dx.doi.org/10.1186/s13104-019-4579-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6743179PMC
September 2019

Ultrasound-guided dry needling decreases pain in patients with piriformis syndrome.

Muscle Nerve 2019 11 27;60(5):558-565. Epub 2019 Aug 27.

Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.

Introduction: Piriformis muscle syndrome (PMS) is a disorder that can lead to symptoms of buttock pain and limited hip-joint mobility, and may have an impact on quality of life.

Methods: Thirty-two patients with PMS were randomized to the treatment group, which included three sessions of ultrasound-guided dry needling (DN) of the piriformis muscle (n = 16), or a waitlist control group (n = 16). The primary outcome was pain intensity measured on the visual analog scale recorded at baseline and then at 72 hours and 1 week after treatment.

Results: At 1-week follow-up, pain intensity was significantly less in the DN group than in the waitlist control group (-2.16 [-1.01 to -3.32], P = .007) by an amount consistent with clinically meaningful improvement.

Discussion: The findings suggest that DN resulted in clinically meaningful short-term improvement in pain intensity of patients with PMS.
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http://dx.doi.org/10.1002/mus.26671DOI Listing
November 2019

The effects of familiarization with loading, weight and size of loading on neuromuscular responses during sudden upper limb loading in chronic low back pain patients.

J Back Musculoskelet Rehabil 2019 ;32(6):847-855

Mahak Society to Support Children with Cancer, Tehran, Iran.

Background: Changes in the motor control of the spine were found in patients with chronic low back pain (CLBP). Sudden loading of the spine is supposed to be the cause of about 12% of lower back injuries. However, some aspects of this problem, such as alterations in the sensory-motor control of the spine, remain questionable.

Objective: To investigate the effects of familiarization with loading, weight and size of loading on neuromuscular responses during sudden upper limb loading in CLBP patients.

Methods: In this quasi-experimental study surface electromyography of the erector spinae (ES) and transverses abdominis/internal oblique (TrA/IO) and external oblique (EOA) muscles were recorded in 7 men and 13 women with CLBP and 20 asymptomatic subjects (10 men and 10 women) aged 18-45 years from the general community familiarization. Moreover, investigating control of the posture measurements of the center of pressure (COP) and vertical ground reaction force (GRF) or Fz were recorded using a force plate. Data were analyzed using paired t-test and independent t-test with the significance level of 0.05.

Results: Data analyses were performed using SPSS version 18. Some electromyography and force plate variables were significantly different for different conditions in each group and between the asymptomatic and low back pain groups (p⩽ 0.05).

Conclusion: Several motor control changes were observed in the CLBP patients. These patients showed decreased trunk muscle activity as well as too early and too delayed responses compared to asymptomatic subjects.
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http://dx.doi.org/10.3233/BMR-181236DOI Listing
March 2020

Quantitative analysis of in patients with chronic rhinosinusitis under continuous ultrasound treatment.

Iran J Microbiol 2018 Dec;10(6):354-360

Department of Medical Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

Background And Objectives: Bacterial pathogens, in particular drug resistant strains, involved in chronic rhinosinusitis may result in treatment failure. Ultrasound waves are able to destroy bacterial population in sinus cavities and can recover patients.

Materials And Methods: Twelve patients with chronic sinusitis and 10 healthy controls were treated by continuous ultrasound waves. Clinical specimens were collected before and after treatment. Serial diluted specimens were cultured on blood agar, chocolate and MacConkey agar plates for bacterial isolation. Bacterial DNA was extracted and used for detection using quantitative PCR.

Results: was the most isolated bacterium (10 patients), which was eradicated from 8 patients after treatment. Using phenotypic methods at the beginning, 3 out of 10 healthy individuals were found to be positive. From 11 positive patients for identified by real time qPCR, 9 showed significant reduction after treatment. In the healthy group, was detected in 4 samples using qPCR, but they were clean at the second sampling.

Conclusion: According to our phenotypic and molecular experiments, continuous ultrasound treatment effectively reduced the bacterial population in studied patients (p < 0.01). This was a hopeful basis for doing more studies with ultrasound therapy as a treatment option.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6414742PMC
December 2018

Comparison of Postural Balance between Subgroups of Nonspecific Low-back Pain Patients Based on O'Sullivan Classification System and Normal Subjects during Lifting.

Arch Bone Jt Surg 2019 Jan;7(1):52-60

Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.

Background: Balance disorder is one of the most-studied fields in low-back pain patients (LBP). However, there is insufficient information regarding the effect of LBP subgrouping on postural control. The purpose of the present study was to compare postural control between subgroups of chronic nonspecific LBP and healthy subjects during lifting.

Methods: A total of 35 men with chronic LBP (19 active extension pattern [AEP] and 16 flexion pattern [FP]) and 15 healthy controls were enrolled in this cross-sectional study. Pooled LBP was subdivided based on the O'Sullivan's classification system (OCS). The participants were asked to lift a box from the ground to the waist level and hold it for 20 seconds. The load was 10% of the subject's weight. Force plate system was used to record balance parameters, including standard deviations (SDs) of center of pressure (COP) amplitude and COP velocity in anterior-posterior and medial-lateral directions and mean total velocity. The test was divided into two static and dynamic phases. Data were analyzed using one-way analysis of variance and independent t-test.

Results: There were no significant differences between pooled LBP and control groups in any of the variables, except for the SD of the anterior-posterior direction velocity in the X-plane in the static phase (). After classifying LBP, the results showed that the healthy and AEP groups were significantly different in SD of COP velocity in the frontal plane (), mean total velocity (), and SD of COP velocity in the sagittal plane ().

Conclusion: The present study showed that postural control was not different between the pooled LBP and normal groups. After classifying pooled LBP based on OCS, we found that the AEP showed different postural control as compared to healthy controls in the dynamic phase. The FP and AEP exhibited different postural control relative to the healthy controls in the static phase, and COP velocity was lower in those groups compared to the control group. The results of this study support the concept of LBP classification.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6372270PMC
January 2019

The Effect of Lumbosacral Orthosis on the Thickness of Deep Trunk Muscles Using Ultrasound Imaging: A Randomized Controlled Trial in Patients With Chronic Low Back Pain.

Am J Phys Med Rehabil 2019 07;98(7):536-544

From the Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran (FA, MK); Department of Physical Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran (IET, JS); School of Rehabilitation Sciences, Tehran Universities of Medical Sciences, Tehran, Iran (GK); and Biomechanics Laboratory, Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran (MP).

Objective: This study was conducted to evaluate the changes occurring in the thickness of deep trunk muscles, measured using ultrasound imaging, after 4 wks of lumbosacral orthosis use in conjunction with routine physical therapy.

Design: This parallel-group, randomized, controlled trial was conducted on 44 patients with nonspecific chronic low back pain, randomly allocated to the experimental and control groups. Both groups received eight sessions of physical therapy twice per week for 4 wks. The experimental group wore nonextensible lumbosacral orthosis, in addition to undergoing routine physical therapy. The thickness of the transversus abdominis, obliquus internus, and lumbar multifidus was measured by ultrasound before and after the 4-wk intervention.

Results: The deep trunk muscles differed in thickness in various test positions. Four weeks of intervention with lumbosacral orthosis and routine physical therapy, however, did not change the thickness of the obliquus internus, transversus abdominis, and lumbar multifidus.

Conclusions: Wearing lumbosacral orthosis for an average of 7.21 hrs/d for 4 wks in conjunction with routine physical therapy did not affect the thickness of obliquus internus, transversus abdominis, and lumbar multifidus.
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http://dx.doi.org/10.1097/PHM.0000000000001135DOI Listing
July 2019

The Ratio of Lumbar to Hip Motion during the Trunk Flexion in Patients with Mechanical Chronic Low Back Pain According to O'Sullivan Classification System: A Cross-sectional Study.

Arch Bone Jt Surg 2018 Nov;6(6):560-569

Research performed at Physical Therapy Clinic of School of Rehabilitation, Iran Universality of Medical Sciences, Tehran, Iran.

Background: Static and dynamic postures of lumbopelvic in low back pain (LBP) are considered as two important aspects of clinical assessment and management of LBP. Thus, the focus of the current study was to compare the posture and compensatory strategy of hip and lumbar region during trunk flexion between LBP subgroupsand health subjects. LBP cases are subdivided into active extension pattern (AEP) and flexion pattern (FP) based on O'Sullivan's classification system (OCS).

Methods: This work was a cross-sectional study involving 72 men, 21 low back pain patients with FP and 31 low back pain patients with AEP and 20 healthy groups. Lumbar and hip angles during trunk flexion were measured by a 3D motion analysis system in neutral standing posture and end-range of trunk flexion. The participants were asked to full bend without any flexion of the knees. The bending speed was preferential. Hip and lumbar ranges of motion were divided into four quartiles (Q). The quartiles were compared between groups. Data analysis was performed using one-way analysis of variance (ANOVA) and independent t-test.

Results: There was no statistically significant difference in lumbar lordosis in standing and full trunk flexion positions between the healthy groups and heterogeneous LBP groups. In addition, there was not any statistically significant difference between the healthy group and the homogenous LBP group (FP and AEP). Moreover, no statistically significant difference was observed in hip angles during standing between the healthy group and the heterogeneous LBP group, and between the healthy group and the homogenous LBP group (FP and AEP). In full trunk flexion position, there was statistically significant difference in hip angles between the healthy group and the heterogeneous LBP group (P=0.026). In this position, the difference in hip angles between the healthy group and FP group was statistically significant (). In the second Q, there was no significant difference between the healthy group and the heterogeneous LBP group (), however, there was a significant difference between FP group and the healthy group in the fourth Q of the total hip range of motion. There was no statistically significant difference between the healthy group and the heterogeneous LBP group () but there was a difference between FP group and the healthy group. Lumbar/hip motion ratio (L/H ratio) was different between and within the subgroups in the second Q.

Conclusion: This study supported the subgrouping of LBP and showed that the difference between subgroups could be determined effectively through subdividing the total range of lumbar and hip motions into smaller portions. It is possible that the neuromuscular system selects different strategies to compensate and prevent further injury of the chain components (muscle, joint, nerve and etc.).

Level Of Evidence: IV.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6310185PMC
November 2018

The effect of dry needling on the active trigger point of upper trapezius muscle: Eliciting local twitch response on long-term clinical outcomes.

J Back Musculoskelet Rehabil 2019 ;32(5):717-724

Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran.

Background: Pain from myofascial trigger points is often treated by dry needling (DN). Empirical evidence suggests eliciting a local twitch response (LTR) during needling is essential. Muscle damage after eliciting LTR can increase the risk of tissue fibrosis in some cases.

Objective: This study aimed to compare two methods of DN including with and without LTR on clinical parameters.

Methods: Twenty-six participants suffering from chronic non-specific neck pain with an active trigger point (TrP) in their upper trapezius muscles were recruited via the convenience sampling method. Participants were randomly assigned in DN with LTR (control group) and without eliciting LTR or "de qi" (experimental group). Then, they received 3 sessions of dry needling, 3 days apart. We evaluated pain, pain pressure threshold, active cervical lateral flexion range of motion, and Neck Disability Index before the intervention and 4 weeks after the treatment.

Results: After the treatment, significant higher changes were seen in the experimental group compared to the control group (p< 0.05) regarding pain, pain pressure threshold, and active cervical lateral flexion. However, there was no significant difference between groups according to the disability (p> 0.05).

Conclusion: DN without eliciting LTR has superiority over the DN along with eliciting LTR while the treatment aimed to receive long-term effects.
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http://dx.doi.org/10.3233/BMR-181286DOI Listing
January 2020

Comparison of pressure release, phonophoresis and dry needling in treatment of latent myofascial trigger point of upper trapezius muscle.

J Back Musculoskelet Rehabil 2019 ;32(4):587-594

Background: Latent myofascial trigger point (LMTP) is a small hypersensitive area in skeletal muscles that becomes painful under compression or stimulation. LMTPs are relevant for various musculoskeletal disorders. Although several treatments have been introduced to treat LMTP, the most efficient one is yet to be found.

Objective: The main purpose of the present study was to compare pressure release, phonophoresis of betamethasone and dry needling on the upper trapezius latent myofascial trigger point.

Methods: Sixty participants (mean ± SD age, 23.6 ± 2.1 y), with at least one latent myofascial trigger point in the upper trapezius muscle, participated in this study. Subjects were randomly divided into three groups (pressure release, phonophoresis with betamethasone and dry needling groups) for two weeks. Pain intensity, pain pressure threshold and active cervical range of motion were assessed.

Results: Significant pain decrease, active cervical range of motion and pain pressure threshold increase were observed in the three groups (p< 0.001). The dry needling and phonophoresis groups reported more significant improvement compared to the pressure release group (p< 0.001). There was no difference between the dry needling and phonophoresis groups.

Conclusions: Considering the significant, positive effects of all three methods, dry needling and phonophoresis seem to be more effective than pressure release.
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http://dx.doi.org/10.3233/BMR-181302DOI Listing
December 2019

Effect of Elastic Therapeutic Taping on Abdominal Muscle Endurance in Patients With Chronic Nonspecific Low Back Pain: A Randomized, Controlled, Single-Blind, Crossover Trial.

J Manipulative Physiol Ther 2018 09 8;41(7):609-620. Epub 2018 Aug 8.

Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.

Objective: The purpose of this study was to determine the immediate effect of elastic therapeutic taping and sham taping of the abdominal musculature on maximum hold time of endurance tests in patients with chronic nonspecific low back pain (CNLBP).

Methods: Twenty-six people with CNLBP and 26 asymptomatic individuals were included in this study. The CNLBP participants were allocated to an elastic therapeutic tape group or a sham tape group. Standard adhesive elastic therapeutic tape was utilized for facilitatory application in the elastic therapeutic tape group. The elastic therapeutic tape group received real elastic therapeutic taping on the transversus abdominis and internal obliques, and the sham tape group received sham elastic therapeutic taping application. For the sham group, the elastic therapeutic tape was positioned horizontally above the navel and applied without tension. After a wash-out period, each CNLBP participant was switched to the other group. Outcome measures included maximum hold time of supine isometric chest raise, supine double straight-leg raise, and abdominal drawing in maneuver.

Results: The CNLBP participants had lower maximum hold time compared to the asymptomatic individuals (P ≤ .01). Following taping, both groups showed an increase in the maximum hold time (mean difference = 4.43 - 50.69 seconds; P ≤ .02). Although there was no difference between the results of both groups (P ≥ .12), effect sizes were large for the elastic therapeutic tape group (Cohen's d = -1.93 to -1.00).

Conclusions: The results suggest that the maximum hold time of endurance tests was decreased in CNLBP patients compared to healthy participants. The application of both elastic therapeutic tape and sham tape to the transversus abdominis and internal obliques produced short-term improvement in abdominal endurance. There was no statistically significant difference between the results of elastic therapeutic tape and sham tape.
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http://dx.doi.org/10.1016/j.jmpt.2017.10.019DOI Listing
September 2018

Gender-Related Differences in Reliability of Thorax, Lumbar, and Pelvis Kinematics During Gait in Patients With Non-specific Chronic Low Back Pain.

Ann Rehabil Med 2018 Apr 30;42(2):239-249. Epub 2018 Apr 30.

Department of Ergonomics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

Objective: To evaluate test-retest reliability of trunk kinematics relative to the pelvis during gait in two groups (males and females) of patients with non-specific chronic low back pain (NCLBP) using three-dimensional motion capture system.

Methods: A convenience sample of 40 NCLBP participants (20 males and 20 females) was evaluated in two sessions. Participants were asked to walk with self-selected speed and kinematics of thorax and lumbar spine were captured using a 6-infrared-cameras motion-analyzer system. Peak amplitude of displacement and its measurement errors and minimal detectable change (MDC) were then calculated.

Results: Intraclass correlation coefficients (ICCs) were relatively constant but small for certain variables (lower lumbar peak flexion in female: inter-session ICC=0.51 and intra-session ICC=0.68; peak extension in male: inter-session ICC=0.67 and intra-session ICC=0.66). The measurement error remained constant and standard error of measurement (SEM) difference was large between males (generally ≤4.8°) and females (generally ≤5.3°). Standard deviation (SD) was higher in females. In most segments, females exhibited higher MDCs except for lower lumbar sagittal movements.

Conclusion: Although ICCs were sufficiently reliable and constant in both genders during gait, there was difference in SEM due to difference in SD between genders caused by different gait disturbance in chronic low back pain. Due to the increasing tendency of measurement error in other areas of men and women, attention is needed when measuring lumbar motion using the method described in this study.
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http://dx.doi.org/10.5535/arm.2018.42.2.239DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5940600PMC
April 2018

A protocol for clinical trial study of the effect of core stabilization exercises on spine kinematics during gait with and without load in patients with non-specific chronic low back pain.

Chiropr Man Therap 2017 16;25:31. Epub 2017 Nov 16.

Department of Ergonomics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

Background: Non-specific chronic low back pain (NCLBP) is a major public health and global socioeconomic burden with a variety of symptoms such as gait abnormality. Trunk stiffness and deep trunk muscles dysfunction known as guarding mechanism in gait are factors leading to abnormal movement pattern of the spine. Anterior load carriage task during gait is also challenged the trunk stability and its movement pattern. It will be therefore of interest to examine the effect of a Core Stabilization Training Program (CSTP) on the trunk and pelvis kinematics including variability and peak displacement during gait with and without load in NCLBP patients.

Methods: Patients with NCLBP will participate in a program containing 16 sessions of CSTP and perceived pain, disability and kinematic will be evaluated with 100 mm visual analog scale (VAS), Oswestry Disability Index (ODI) and motion analyzing system respectively before and after the intervention. Participants will be asked to walk with self-selected comfortable speed for 3 times without load and 3 times with caring a load with hands.

Discussions: We will quantify the effectiveness of CSTP on the kinematic of trunk, lumbar and pelvis during gait. Comparing the kinematic pattern and movement variability using CV and CV can contribute to better understand the motor control strategy and movement pattern of the spine during an anterior load carriage task between patients with NCLBP and healthy.

Trial Registration: IRCT number: IRCT2016080829264N1; pre-result.
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http://dx.doi.org/10.1186/s12998-017-0162-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5688737PMC
July 2018

Test-retest reliability of sit-to-stand and stand-to-sit analysis in people with and without chronic non-specific low back pain.

Musculoskelet Sci Pract 2018 06 6;35:95-104. Epub 2017 Nov 6.

Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.

Background: Sit-to-stand (STD) and stand-to-sit (SIT) analysis can provide information on functional independence in daily activities in patients with low back pain (LBP). However, in order for measurements to be clinically useful, data on psychometric properties should be available.

Objectives: The main purpose was to investigate intra-rater reliability of STD and SIT tasks in participants with and without chronic non-specific LBP (CNLBP). The second purpose was to detect any differences in lumbar spine and hips sagittal plane kinematics and coordination between asymptomatic individuals and CNLBP patients during STD and SIT.

Design: Cross-sectional study.

Method: Twenty-three CNLBP patients and 23 demographically-matched controls were recruited. Ten markers were placed on specific anatomical landmarks. Participants were asked to perform STD and SIT at a preferred speed. Peak flexion angles, mean angular velocities, lumbar to hip movement ratios, and relative phase angles were measured. The procedure was repeated after 2 h and 6-8 days. Differences between two groups were analyzed using independent t-test. Intraclass correlation coefficient (ICC 3,k), standard error of measurement (SEM), and limits of agreement (LOAs) were also estimated.

Results: The ICC values showed moderate to excellent intra-rater reliability, with relatively low SEM values (≤10.17°). The 95% LOAs demonstrated that there were no differences between the measured parameters. Furthermore, CNLBP patients had limited sagittal plane angles, smaller angular velocities, and lumbar-hip dis-coordination compared to asymptomatic participants.

Conclusions: The results indicated moderate to excellent test-retest reliability of STD and SIT analysis. Moreover, CNLBP patients had altered kinematics during STD and its reverse.
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http://dx.doi.org/10.1016/j.msksp.2017.11.001DOI Listing
June 2018

Kinematics of the Spine During Sit-to-Stand Movement Using Motion Analysis Systems: A Systematic Review of Literature.

J Sport Rehabil 2019 Jan;28(1):77-93

Context: Clinical evaluation of the spine is commonplace in musculoskeletal therapies, such as physiotherapy, physical medicine/rehabilitation, osteopathic, and chiropractic clinics. Sit-to-stand (STS) is one of the most mechanically demanding daily activities and crucial to independence. Difficulty or inability to perform STS is common in individuals with a variety of motor disabilities, such as low back pain (LBP).

Objective: The purpose of this systematic review was to evaluate available evidence in literature to determine 2-dimensional and 3-dimensional kinematics of the spine during STS in patients with LBP and healthy young adult participants using motion analysis systems (electromagnetic and marker based).

Methods: Electronic databases (PubMed/MEDLINE [National Library of Medicine], Scopus, ScienceDirect, and Google Scholar) were searched between January 2002 and February 2017. Additionally, the reference lists of the articles that met the inclusion criteria were also searched. Prospective studies published in peer-reviewed journals, with full text available in English, investigating the kinematics of the spine during STS in healthy subjects (mean age between 18 and 50 y) or in patients with LBP using motion analysis systems, were included. Sixteen studies fulfilled the eligibility criteria. All information relating to methodology and kinematic modeling of the spine segments along with the outcome measures was extracted from the studies identified for synthesis.

Results: The results indicated that the kinematics of the spine are greatly changed in patients with LBP. In order to develop a better understanding of spine kinematics, studies recommended that the trunk should be analyzed as a multisegment. It has been shown that there is no difference between the kinematics of patients with LBP and healthy population when the spine is analyzed as a single segment. Furthermore, between-gender differences are present during STS movement.

Conclusion: This review provided a valuable summary of the research to date examining the kinematics of the spine during STS.
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http://dx.doi.org/10.1123/jsr.2017-0147DOI Listing
January 2019

A new iPhone application for measuring active craniocervical range of motion in patients with non-specific neck pain: a reliability and validity study.

Spine J 2018 03 7;18(3):447-457. Epub 2017 Sep 7.

Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Evin, Koodakyar Ave., Tehran, 1985713831, Iran; University Institute of Physical Therapy, Faculty of Allied Health Sciences, University of Lahore, Lahore, 54000, Pakistan.

Background Context: Measurement of cervical spine range of motion (ROM) is often considered to be an essential component of cervical spine physiotherapy assessment.

Purpose: This study aimed to investigate the reliability and validity of an iPhone application (app) (Goniometer Pro) for measuring active craniocervical ROM (ACCROM) in patients with non-specific neck pain.

Study Design/setting: A cross-sectional study was conducted at the musculoskeletal biomechanics laboratory located at Iran University of Medical Sciences.

Patient Sample: Forty non-specific neck pain patients participated in this study.

Outcome Measures: The outcome measure was the ACCROM, including flexion, extension, lateral flexion, and rotation.

Method: Following the recruitment process, ACCROM was measured using a universal goniometer (UG) and iPhone 7 app. Two blinded examiners each used the UG and iPhone to measure ACCROM in the following sequences: flexion, extension, lateral flexion, and rotation. The second (2 hours later) and third (48 hours later) sessions were carried out in the same manner as the first session. Intraclass correlation coefficient (ICC) models were used to determine the intra-rater and inter-rater reliability. The Pearson correlation coefficients were used to establish concurrent validity of the iPhone app. Minimum detectable change at the 95% confidence level (MDC) was also computed.

Results: Good intra-rater and inter-rater reliability was demonstrated for the goniometer with ICC values of ≥0.66 and ≥0.70 and the iPhone app with ICC values of ≥0.62 and ≥0.65, respectively. The MDC ranged from 2.21° to 12.50° for the intra-rater analysis and from 3.40° to 12.61° for the inter-rater analysis. The concurrent validity between the two instruments was high, with r valuesof ≥0.63. The magnitude of the differences between the UG and iPhone app values (effect sizes) was small, with Cohen d values of ≤0.17.

Conclusions: The iPhone app possesses good reliability and high validity. It seems that this app can be used for measuring ACCROM.
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http://dx.doi.org/10.1016/j.spinee.2017.08.229DOI Listing
March 2018

Comparison of spinal stability following motor control and general exercises in nonspecific chronic low back pain patients.

Clin Biomech (Bristol, Avon) 2017 Oct 8;48:42-48. Epub 2017 Jul 8.

Division of Applied Mechanics, Department of Mechanical Engineering, École Polytechnique, Montréal, Canada.

Background: Motor control exercise was claimed to improve spinal stability in patients with chronic non-specific back pain, but to investigate the effectiveness of this exercise, other outcome measures have been used rather than spinal stability itself. The aim of our study is to assess motor control exercise effects on spinal stability using a biomechanical model.

Methods: Fifty-one patients were assigned to either motor control or general exercises. Before and after trainings, participants were tested for spinal stability at seven isometric tasks. Electromyography signals were recorded from ten superficial muscles, and a hybrid EMG-driven musculoskeletal model estimated spinal stability indices at each task.

Findings: Pain and disability significantly decreased in both groups. After trainings, patients had both increase and decrease in stability depending on the task, and stability did not increase/decrease uniformly in all patients. In the motor control group, stability increased at all positions but reached to significance only at right lateral pulling. In the general exercise group, except for pulling the trunk backward, stability decreased at other positions and reached to statistical significance only at pulling the trunk forward. No significant difference between groups was found in changing stability after the intervention.

Interpretation: Interventions yielded no significant difference in disability, pain and stability index between two groups. Significant increase of stability in the motor control group at right lateral pulling may be attributed to more activity of abdominal muscles, and significant decrease of stability in the general exercise group at forward pulling may be attributed to more optimal activity of back muscles.
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http://dx.doi.org/10.1016/j.clinbiomech.2017.07.006DOI Listing
October 2017

The Effect of Core Stabilization Exercise on the Kinematics and Joint Coordination of the Lumbar Spine and Hip During Sit-to-Stand and Stand-to-Sit in Patients With Chronic Nonspecific Low Back Pain (COSCIOUS): Study Protocol for a Randomized Double-Blind Controlled Trial.

JMIR Res Protoc 2017 Jun 1;6(6):e109. Epub 2017 Jun 1.

Department of Physical Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic Of Iran.

Background: Chronic nonspecific low back pain (CNLBP) is among the most prevalent health problems. Lumbar spine and hips kinematics and coordination can be affected in CNLBP. The effects of exercises on the kinematics and coordination of lumbar spine and hips during sit-to-stand (STS) and its reverse have not been evaluated.

Objective: The aim of this study is to investigate the effect of core stabilization exercise on the kinematics and joint coordination of the lumbar spine and hip during STS and its reverse in CNLBP patients.

Methods: COSCIOUS is a parallel randomized double-blind controlled trial. A total of 30 CNLBP patients and 15 asymptomatic participants will be included. The kinematics and joint coordination of the lumbar spine and hips will be evaluated during STS and its reverse using a motion capture system. The participants will be asked to sit in their usual posture on a stool. Reflective markers will be placed over the T12, S2, anterior and posterior superior iliac spines, greater trochanters, and lateral femoral epicondyles of both legs. The participants will be instructed to stand up at natural speed, remain in the erect posture for 3 seconds, and then sit down. Kinematic variables of the lumbar spine and hip will be computed. Afterward, the CNLBP participants will be allocated at random to receive one of 2 interventions: core stabilization or general exercise. Treatment sessions will be held 3 times per week for 16 sessions. After intervention, CNLBP participants will be assessed again.

Results: Funding for the study was provided in 2016 by Iran University of Medical Sciences. The study is expected to last approximately 12 months, depending on recruitment. Findings on the study's primary outcomes are expected to be finalized by December 2017. The results of the study will be published in a peer-reviewed journal.

Conclusions: This investigation will evaluate the effects of core stabilization exercise on the kinematics and joint coordination of the lumbar spine and hip during STS and its reverse in patients with CNLBP. In addition, the effects of CNLBP on STS and its reverse will be investigated in COSCIOUS.

Trial Registration: Iranian Registry of Clinical Trials IRCT2016080812953N2; http://en.search.irct.ir/view/32003?format=xml (Archived by WebCite at http://www.webcitation.org/6qjTWd4Az).
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http://dx.doi.org/10.2196/resprot.7378DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5472842PMC
June 2017

Reliability and concurrent validity of a new iPhone goniometric application for measuring active wrist range of motion: a cross-sectional study in asymptomatic subjects.

J Anat 2017 03 2;230(3):484-495. Epub 2016 Dec 2.

Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

Measurement of wrist range of motion (ROM) is often considered to be an essential component of wrist physical examination. The measurement can be carried out through various instruments such as goniometers and inclinometers. Recent smartphones have been equipped with accelerometers and magnetometers, which, through specific software applications (apps) can be used for goniometric functions. This study, for the first time, aimed to evaluate the reliability and concurrent validity of a new smartphone goniometric app (Goniometer Pro©) for measuring active wrist ROM. In all, 120 wrists of 70 asymptomatic adults (38 men and 32 women; aged 18-40 years) were assessed in a physiotherapy clinic located at the School of Rehabilitation Sciences, Iran University of Medical Science and Health Services, Tehran, Iran. Following the recruitment process, active wrist ROM was measured using a universal goniometer and iPhone 5 app. Two blinded examiners each utilized the universal goniometer and iPhone to measure active wrist ROM using a volar/dorsal alignment technique in the following sequences: flexion, extension, radial deviation, and ulnar deviation. The second (2 h later) and third (48 h later) sessions were carried out in the same manner as the first session. All the measurements were conducted three times and the mean value of three repetitions for each measurement was used for analysis. Intraclass correlation coefficient (ICC) models (3, k) and (2, k) were used to determine the intra-rater and inter-rater reliability, respectively. The Pearson correlation coefficients were used to establish concurrent validity of the iPhone app. Good to excellent intra-rater and inter-rater reliability was demonstrated for the goniometer with ICC values of ≥ 0.82 and ≥ 0.73 and the iPhone app with ICC values of ≥ 0.83 and ≥ 0.79, respectively. Minimum detectable change at the 95% confidence level (MDC ) was computed as 1.96 × standard error of measurement × √2. The MDC ranged from 1.66° to 5.35° for the intra-rater analysis and from 1.97° to 6.15° for the inter-rater analysis. The concurrent validity between the two instruments was high, with r values of ≥ 0.80. From the results of this cross-sectional study, it can be concluded that the iPhone app possesses good to excellent intra-rater and inter-rater reliability and concurrent validity. It seems that this app can be used for the measurement of wrist ROM. However, further research is needed to evaluate symptomatic subjects using this app.
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http://dx.doi.org/10.1111/joa.12568DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5314391PMC
March 2017

Role of the Internal Superior Laryngeal Nerve in the Motor Responses of Vocal Cords and the Related Voice Acoustic Changes.

Iran J Med Sci 2016 Sep;41(5):374-81

Department of Speech and Language Pathology, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.

Background: Repeated efforts by researchers to impose voice changes by laryngeal surface electrical stimulation (SES) have come to no avail. This present pre-experimental study employed a novel method for SES application so as to evoke the motor potential of the internal superior laryngeal nerve (ISLN) and create voice changes.

Methods: Thirty-two normal individuals (22 females and 10 males) participated in this study. The subjects were selected from the students of Iran University of Medical Sciences in 2014. Two monopolar active electrodes were placed on the thyrohyoid space at the location of the ISLN entrance to the larynx and 1 dispersive electrode was positioned on the back of the neck. A current with special programmed parameters was applied to stimulate the ISLN via the active electrodes and simultaneously the resultant acoustic changes were evaluated. All the means of the acoustic parameters during SES and rest periods were compared using the paired t-test.

Results: The findings indicated significant changes (P=0.00) in most of the acoustic parameters during SES presentation compared to them at rest. The mean of fundamental frequency standard deviation (SD F0) at rest was 1.54 (SD=0.55) versus 4.15 (SD=3.00) for the SES period. The other investigated parameters comprised fundamental frequency (F0), minimum F0, jitter, shimmer, harmonic-to-noise ratio (HNR), mean intensity, and minimum intensity.

Conclusion: These findings demonstrated significant changes in most of the important acoustic features, suggesting that the stimulation of the ISLN via SES could induce motor changes in the vocal folds. The clinical applicability of the method utilized in the current study in patients with vocal fold paralysis requires further research.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4967481PMC
September 2016

The effect of core stability and general exercise on abdominal muscle thickness in non-specific chronic low back pain using ultrasound imaging.

Physiother Theory Pract 2016 May;32(4):277-83

b Physiotherapy Department, School of Rehabilitation Sciences , Iran University of Medical Sciences , Tehran , Iran.

Background: There is a controversy regarding whether core stability exercise (CSE) is more effective than general exercise (GE) for chronic LBP. To compare different exercises regarding their effect on improving back strength and stability, performance of abdominal muscles is a useful index. Ultrasound imaging for measuring muscle thickness could be used to assess muscle performance.

Objective: The aim of this study was to compare CSE and GE in chronic LBP using ultrasound imaging for measurement of thickness of the deep stabilizing and main global trunk muscles in non-specific chronic LBP.

Methods: Each program included 16 training sessions three times a week. Using ultrasound imaging, four transabdominal muscle thickness were measured before and after the intervention. Disability and pain were measured as secondary outcomes.

Results: After the intervention on participants (n = 43), a significant increase in muscle thickness (hypertrophy) was seen only in right and left rectus abdominis in the GE group, but significant difference to the CSE group was only on the right side. Disability and pain reduced within the groups without a significant difference in the change between them.

Conclusions: The present results provided evidence that only GE increased right and left rectus muscle thickness. The only significant difference between CSE and GE groups was the right rectus thickness. As rectus is a global muscle, the effect of GE on strength improvement (one side stronger than the other) may have a negative effect on motor control of lumbopelvic muscles and possibly increase the risk of back pain occurring or becoming worse, though this was not observed in the present study.
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http://dx.doi.org/10.3109/09593985.2016.1138559DOI Listing
May 2016

The effects of arm movement on reaction time in patients with latent and active upper trapezius myofascial trigger point.

Med J Islam Repub Iran 2015 16;29:295. Epub 2015 Nov 16.

Assistant Professor, Physical Therapy Department, Rehabilitation Faculty, Iran University of Medical Sciences, Tehran, Iran.

Background: Myofascial pain syndrome is a significant source of mechanical pain. The aim of this study was to investigate the effects of arm movement on reaction time in females with latent and active upper trapezius myofascial trigger point.

Methods: In this interventional study, a convenience sample of fifteen women with one active MTP, fifteen women with one latent MTP in the upper trapezius, and fifteen normal healthy women were participated. Participants were asked to stand for 10 seconds in an erect standing position. Muscle reaction times were recorded including anterior deltoid (AD), cervical paraspinal (CP) lumbar paraspinal (LP), both of upper trapezius (UT), sternocleidomastoid (SCM) and medial head of gastrocnemius (GcM). Participants were asked to flex their arms in response to a sound stimulus preceded by a warning sound stimulus. Data were analyzed using one-way ANOVA Test.

Results: There was significant differences in motor time and reaction time between active and control groups (p< 0.05) except for GcM. There was no significant difference in motor time between active and passive groups except for UT without MTP and SCM (p< 0.05). Also, there were no significant differences in motor times between latent MTP and control groups. Furthermore, there was no significant difference in premotor times between the three groups.

Conclusion: The present study shows that patients with active MTP need more time to react to stimulus, but patients with latent MTP are similar to healthy subjects in the reaction time. Patients with active MTP had less compatibility with environmental stimulations, and they responded to a specific stimulation with variability in Surface Electromyography (SEMG).
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4764279PMC
February 2016