Publications by authors named "Masood Mazaheri"

41 Publications

Magnitude, symmetry and attenuation of upper body accelerations during walking in women: The role of age, fall history and walking surface.

Maturitas 2020 Sep 3;139:49-56. Epub 2020 Jun 3.

Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran.

Objectives: The present experiment examined the role of age and fall history in upper body accelerations when walking on an even and on an uneven surface.

Study Design: An observational cross-sectional study.

Main Outcome Measures: The magnitude (root mean square [RMS]), symmetry (harmonic ratio) and attenuation (attenuation coefficient) of upper body accelerations were quantified as primary outcomes; gait spatiotemporal parameters were measured as secondary outcomes.

Methods: Twenty young adults (mean ± SD age: 29.00 ± 4.51 yrs), 20 older non-fallers (66.60 ± 5.43 yrs) and 20 older fallers (68.55 ± 4.86 yrs) walked on an even and on an uneven surface, while wearing four accelerometers attached to the forehead, pelvis, right and left shanks.

Results: Older fallers exhibited increased RMS acceleration in the mediolateral direction at the pelvis level compared with young adults when walking on the even surface (0.18 ± 0.04 vs. 0.14 ± 0.02, respectively), whereas walking on an uneven surface was associated with reduced magnitude of acceleration in older fallers (0.19 ± 0.04) compared with non-fallers (0.23 ± 0.04) and young adults (0.22 ± 0.03). Among other changes, walking on the uneven surface diminished pelvis-to-head attenuation in the mediolateral direction in older fallers (38.07 ± 14.51) compared with non-fallers (50.96 ± 11.03) and young adults (62.62 ± 8.21; all ps<0.05).

Conclusions: Reduced mediolateral accelerations in older fallers when walking on the uneven surface can be interpreted as a compensatory mechanism to preserve stability through increased body stiffness. Reduced postural flexibility in the frontal plane compromises the central role of the trunk in minimizing the impact of gait-related oscillations to the head, as evidenced by reduced mediolateral attenuation in older fallers.
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http://dx.doi.org/10.1016/j.maturitas.2020.05.016DOI Listing
September 2020

Sex and freezing of gait in Parkinson's disease: a systematic review and meta-analysis.

J Neurol 2021 Jan 30;268(1):125-132. Epub 2020 Jul 30.

Department of Rehabilitation, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, PO Box 9101, 6500, Nijmegen, HB, The Netherlands.

Objective: It is unknown how sex affects the prevalence of freezing of gait (FOG). We conducted a systematic review and meta-analysis to establish the sex-specific prevalence of FOG in persons with Parkinson's disease (PD). In addition, we investigated whether men and women were represented accurately in intervention trials targeting FOG.

Methods: We queried the EMBASE and PubMed databases and identified 2637 articles. Of these, 16 epidemiological studies were included in the meta-analysis, and 51 intervention studies were included in the comparative analysis.

Results: In total, 5702 persons were included in the final meta-analysis of epidemiological studies. The pooled estimate of overall FOG prevalence was 43% [95% CI 33-53%]. We found no difference in FOG prevalence between men [44% (34-54%)] and women [42% (31-52%)] with PD. However, women were markedly underrepresented in intervention trials targeting FOG, with an average proportion of only 29.6% of women in trial populations. The percentage of women included in trials was similar across intervention types but differed greatly across geographical regions.

Conclusion: Sex is not a predictor of FOG. This could aid clinicians in counseling persons with PD about FOG. Importantly, a global effort is needed to include more women into clinical trials. Given the skewed distribution of men and women included in intervention trials targeting FOG, caution might be warranted when extrapolating results from FOG trials to women.
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http://dx.doi.org/10.1007/s00415-020-10117-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7815550PMC
January 2021

The effects of cryotherapy versus cryostretching on clinical and functional outcomes in athletes with acute hamstring strain.

J Bodyw Mov Ther 2018 Jul 31;22(3):805-809. Epub 2017 Aug 31.

Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.

Purpose: Hamstring strain is a common sport injury that results in pain and functional limitation. Despite its high frequency in active populations, there is no agreement regarding the best method used for early intervention of hamstring strain. The aim of the present study was to compare the effects of cryotherapy and cryostretching on clinical and functional outcomes in athletes with acute hamstring strain.

Materials And Methods: Thirty seven elite athletes with an acute grade I or II hamstring strain were randomly assigned to either cryotherapy (n = 19) or cryostretching (n = 18) group, receiving 5 sessions of supervised treatment plus home-based intervention monitored by the therapist. Pre-treatment to post-treatment changes in pain, active and passive knee extension range of motion and functional status were compared between the two groups.

Results: Compared to cryotherapy, cryostretching resulted in larger improvement of function and passive knee extension range of motion. Changes in active knee extension range of motion and pain severity were not significantly different between the two groups.

Conclusion: A rehabilitation protocol involving gentle stretching following cryotherapy is more effective than cryotherapy alone in the improvement of function and passive knee range of motion in patients with grade I and II hamstring strain.
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http://dx.doi.org/10.1016/j.jbmt.2017.08.007DOI Listing
July 2018

A Persian-version of the stuttering severity instrument-version four (SSI-4): How the new additions to SSI-4 complement its stuttering severity score?

J Commun Disord 2018 Jul - Aug;74:1-9. Epub 2018 Apr 23.

Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, The Netherlands.

Purpose: The fourth version of the Stuttering Severity Instrument (SSI-4) has been available since 2009. It has some modifications and new features which make it more appropriate at least for clinical practice, although further documentation is needed. The objective of the current research was to translate SSI-4 into Persian language and to discuss its relative and absolute reliability as well as its criterion validity for Persian adults who stutter (PWS). We also aimed to study how the new subjective self-reports of the SSI-4 complement the stuttering severity score obtained from the SSI-3 or the SSI-4.

Method: The cross-cultural guideline recommended by the International Quality of Life Assessment project was used to translate the SSI-4 into Persian language. Thirty five PWS from ages 17 to 42 were recruited and 10 speech and language pathologists assessed their stuttering severity using either the SSI-4 or stuttering severity ratings (SR) to test validity and reliability of the Persian translated version.

Results: A very high inter-judge relative reliability along with a poor absolute inter-judge reliability was found for the SSI-4 scores. The results were more promising for the intra-judge absolute reliability. Test-retest reliability of the complementary questions to the SSI-4 was also found acceptable. However, no strong relationship was found between the SSI-4 scores and its complementary questions.

Conclusion: The Persian version of the SSI-4 can be used reliably by trained SLPs for research and clinical purposes, but not to document small changes in stuttering severity. We argue that the response of participants to the complementary self-report questions should also be considered in calculating their stuttering severity score.
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http://dx.doi.org/10.1016/j.jcomdis.2018.04.005DOI Listing
August 2019

Dual-Tasking Effects on Dynamic Postural Stability in Athletes With and Without Anterior Cruciate Ligament Reconstruction.

J Sport Rehabil 2016 Dec 24;25(4):324-329. Epub 2016 Aug 24.

Purpose: To compare the effect of dual tasking on postural stability between patients with anterior cruciate ligament reconstruction (ACL-R) and healthy controls.

Methods: Single-limb postural stability was assessed in 17 athletes with ACL-R and 17 healthy matched athletes while standing on a Biodex Balance System platform in 4 conditions: stability level of 8 (ie, more-stable support surface) with eyes open, stability level of 8 with eyes closed, stability level of 6 (ie, less-stable support surface) with eyes open, and stability level of 6 with eyes closed. Postural-stability tasks were performed with and without auditory Stroop task. The anteroposterior stability index (APSI), mediolateral stability index (MLSI), and overall stability index (OSI) as measures of postural performance, as well as reaction time and error ratio as measures of cognitive performance, were recorded.

Results: Dual-tasking effect on postural stability was not significantly different between the groups in 3 postural conditions. Only in level 6 with eyes open, for APSI and OSI, patients with ACL-R showed lower postural stability under the dual-task condition. However, patients showed poorer performance on both reaction time and error ratio in all postural conditions.

Conclusions: The patients with ACL-R appeared to sacrifice their cognitive performance to optimize their performance on postural stability. This posture-first strategy was reflected by a more pronounced effect of dual tasking on the auditory Stroop task than the postural-stability task. In situations where maintenance of posture is challenging, giving priority to the postural task at the expense of cognitive performance can ensure safety from balance loss.
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http://dx.doi.org/10.1123/jsr.2015-0012DOI Listing
December 2016

Attentional costs of walking are not affected by variations in lateral balance demands in young and older adults.

Gait Posture 2016 05 11;46:126-31. Epub 2016 Mar 11.

MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.

Increased attentional costs of walking in older adults have been attributed to age-related changes in visuomotor and/or balance control of walking. The present experiment was conducted to examine the hypothesis that attentional costs of walking vary with lateral balance demands during walking in young and older adults. Twenty young and twenty older adults walked on a treadmill at their preferred walking speed under five conditions: unconstrained normal walking, walking on projected visual lines corresponding to either the participant's preferred step width or 50% thereof (i.e. increased balance demand), and walking within low- and high-stiffness lateral stabilization frames (i.e. lower balance demands). Attentional costs were assessed using a probe reaction-time task during these five walking conditions, normalized to baseline performance as obtained during sitting. Both imposed step-width conditions were more attentionally demanding than the three other conditions, in the absence of any other significant differences between conditions. These effects were similar in the two groups. The results indicate that the attentional costs of walking were, in contrast to what has been postulated previously, not influenced by lateral balance demands. The observed difference in attentional costs between normal walking and both visual lines conditions suggests that visuomotor control processes, rather than balance control, strongly affect the attentional costs of walking. A tentative explanation of these results may be that visuomotor control processes are mainly governed by attention-demanding cortical processes, whereas balance is regulated predominantly subcortically.
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http://dx.doi.org/10.1016/j.gaitpost.2016.03.004DOI Listing
May 2016

Effects of narrow base gait on mediolateral balance control in young and older adults.

J Biomech 2016 05 16;49(7):1264-1267. Epub 2016 Mar 16.

MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, The Netherlands. Electronic address:

The aim of this study was to examine the effect of narrowing step width on mediolateral (ML) center of mass (COM) kinematics and margin of stability (MOS) in young and older adults. Fourteen young and 18 healthy older adults were asked to walk on a treadmill at preferred speed, stepping on projected lines at their predetermined preferred step width (PSW) and at a 50% narrowed step width (NSW). Linear trunk accelerations were recorded by an inertial sensor, attached at the level of the lumbar spine and foot placement was determined from force sensors in the treadmill. Mediolateral peak-to-peak COM displacement, COM velocity and MOS within strides were estimated. Mean ML-COM displacement and velocity, which were significantly higher in older compared to young adults, were significantly reduced in the NSW condition while the variability of ML-COM velocity was increased in the NSW condition. A significant interaction effect of step width and age was found for ML-COM velocity, showing larger decreases in older adults in the NSW condition. Walking with NSW reduced the ML-MOS significantly in both groups while it was smaller in the older group. Although reductions of ML-COM displacement and velocity may occur as direct mechanical effects of reduced step width, the larger variability of ML COM velocity in the older adults suggests active control of ML COM movements in response to the reduced base of support. Given the effects on MOS, narrowing step width might challenge ML-balance control and lead to less robust gait especially in older adults.
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http://dx.doi.org/10.1016/j.jbiomech.2016.03.011DOI Listing
May 2016

Effects of narrow-base walking and dual tasking on gait spatiotemporal characteristics in anterior cruciate ligament-injured adults compared to healthy adults.

Knee Surg Sports Traumatol Arthrosc 2017 Aug 9;25(8):2528-2535. Epub 2016 Feb 9.

Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, MOVE Research Institute Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.

Purpose: The present experiment was conducted to examine the hypothesis that challenging control through narrow-base walking and/or dual tasking affects ACL-injured adults more than healthy control adults.

Methods: Twenty male ACL-injured adults and twenty healthy male adults walked on a treadmill at a comfortable speed under two base-of-support conditions, normal-base versus narrow-base, with and without a cognitive task. Gait patterns were assessed using mean and variability of step length and mean and variability of step velocity. Cognitive performance was assessed using the number of correct counts in a backward counting task.

Results: Narrow-base walking resulted in a larger decrease in step length and a more pronounced increase in variability of step length and of step velocity in ACL-injured adults than in healthy adults. For most of the gait parameters and for backward counting performance, the dual-tasking effect was similar between the two groups.

Conclusions: ACL-injured adults adopt a more conservative and more unstable gait pattern during narrow-base walking. This can be largely explained by deficits of postural control in ACL-injured adults, which impairs gait under more balance-demanding conditions. The observation that the dual-tasking effect did not differ between the groups may be explained by the fact that walking is an automatic process that involves minimal use of attentional resources, even after ACL injury. Clinicians should consider the need to include aspects of terrain complexity, such as walking on a narrow walkway, in gait assessment and training of patients with ACL injury.

Level Of Evidence: III.
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http://dx.doi.org/10.1007/s00167-016-4014-4DOI Listing
August 2017

Effects of aging and dual tasking on step adjustments to perturbations in visually cued walking.

Exp Brain Res 2015 Dec 23;233(12):3467-74. Epub 2015 Aug 23.

Department of Kinesiology, KU Leuven, Leuven, Belgium.

Making step adjustments is an essential component of walking. However, the ability to make step adjustments may be compromised when the walker's attentional capacity is limited. This study compared the effects of aging and dual tasking on step adjustments in response to stepping-target perturbations during visually cued treadmill walking. Fifteen older adults (69.4 ± 5.0 years; mean ± SD) and fifteen young adults (25.4 ± 3.0 years) walked at a speed of 3 km/h on a treadmill. Both groups performed visually cued step adjustments in response to unpredictable shifts of projected stepping targets in forward (FW), backward (BW) or sideward (SW) directions, at different levels of task difficulty [which increased as the available response distance (ARD) decreased], and with and without dual tasking (auditory Stroop task). In both groups, step adjustments were smaller than required. For FW and BW shifts, older adults undershot more under dual-task conditions. For these shifts, ARD affected the age groups differentially. For SW shifts, larger errors were found for older adults, dual tasking and the most difficult ARD. Stroop task performance did not differ between groups in all conditions. Older adults have more difficulty than young adults to make corrective step adjustments while walking, especially under dual-tasking conditions. Furthermore, they seemed to prioritize the cognitive task over the step adjustment task, a strategy that may pose aging populations at a greater fall risk. For comparable task difficulty, the older adults performed considerably worse than the young adults, indicating a decreased ability to adjust steps under time pressure.
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http://dx.doi.org/10.1007/s00221-015-4407-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4646946PMC
December 2015

Competing effects of pain and fear of pain on postural control in low back pain?

Spine (Phila Pa 1976) 2014 Dec;39(25):E1518-23

*MOVE Research Institute Amsterdam, Faculty of Human Move-ment Sciences, VU University Amsterdam, Amsterdam, the Netherlands †Musculoskeletal Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; and ‡Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Study Design: A cross-sectional, observational study.

Objective: To determine whether pain and fear of pain have competing effects on postural sway in patients with low back pain (LBP).

Summary Of Background Data: Competing effects of pain and pain-related fear on postural control can be proposed as the likely explanation for inconsistent results regarding postural sway in the LBP literature. We hypothesized that although pain might increase postural sway, fear of pain might reduce sway through an increased cognitive effort or increased cocontraction to restrict body movement. The cognitive strategy would be less effective under dual-task conditions and the cocontraction strategy was expected to be less effective when standing on a narrow base of support surface.

Methods: Postural sway was measured in combined conditions of base of support (full and narrow) and cognitive loading (single and dual tasks) in 3 experimental groups with current LBP, recent LBP, and no LBP. Sway amplitude, path length, mean power frequency, and sample entropy were extracted from center-of-pressure data.

Results: The current-LBP group and recent-LBP group reported significantly different levels of pain, but similar levels of pain catastrophizing and kinesiophobia. The current-LBP group tended to display larger sway amplitudes in the anteroposterior direction compared with the other 2 groups. Mean power frequency values in mediolateral direction were lower in patients with the current LBP compared with recent LBP. Smaller sample entropy was found in the current-LBP group than the other groups in most experimental conditions, particularly when standing on a narrow base of support.

Conclusion: Alterations of postural sway are mostly mediated by pain but not pain-related fear. LBP tends to increase sway amplitude, which seems to be counteracted by increased effort invested in postural control leading to decreased frequency and increased regularity of sway particularly under increased task demands.

Level Of Evidence: Cross-sectional study.
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http://dx.doi.org/10.1097/BRS.0000000000000605DOI Listing
December 2014

Attentional costs of visually guided walking: effects of age, executive function and stepping-task demands.

Gait Posture 2014 2;40(1):182-6. Epub 2014 Apr 2.

MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands.

During walking, attention needs to be flexibly allocated to deal with varying environmental constraints. This ability may be affected by aging and lower overall executive function. The present study examined the influence of aging and executive function on the attentional costs of visually guided walking under different task demands. Three groups, young adults (n=15) and elderly adults with higher (n=16) and lower (n=10) executive function, walked on a treadmill in three conditions: uncued walking and walking with regular and irregular patterns of visual stepping targets projected onto the belt. Attentional costs were assessed using a secondary probe reaction time task and corrected by subtracting baseline single-task reaction time, yielding an estimate of the additional attentional costs of each walking condition. We found that uncued walking was more attentionally demanding for elderly than for young participants. In young participants, the attentional costs increased significantly from uncued to regularly cued to irregularly cued walking, whereas for the higher executive function group, attentional costs only increased significantly from regularly cued to irregularly cued walking. For the group with lower executive function, no significant differences were observed. The observed decreased flexibility of elderly, especially those with lower executive function, to allocate additional attentional resources to more challenging walking conditions may be attributed to the already increased attentional costs of uncued walking, presumably required for visuomotor and/or balance control of walking.
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http://dx.doi.org/10.1016/j.gaitpost.2014.03.183DOI Listing
August 2015

Effect of dual-tasking on dynamic postural control in individuals with and without nonspecific low back pain.

J Manipulative Physiol Ther 2014 Mar-Apr;37(3):170-9. Epub 2014 Mar 15.

MSc in Energy Engineering, Amirkabir University of Technology, Tehran, Iran.

Objective: The purpose of this study was to compare the effect of dual tasking on postural and cognitive performance between participants with and without nonspecific chronic low back pain.

Methods: In this 3-factor mixed-design study, dynamic postural stability was assessed in 15 patients with chronic nonspecific low back pain and 15 age-, sex-, and size-matched asymptomatic participants. Bilateral stance on a Biodex Balance System was investigated at 3 levels of postural task difficulty (different platform stabilities levels with eyes open and closed) and 2 levels of cognitive task difficulty (with or without auditory Stroop test). We measured anterior-posterior, medial-lateral, and overall indices for postural performance. Average reaction time and error ratio of a modified auditory Stroop test were calculated as measures of the cognitive task performance.

Results: Mixed-design 3-way analyses of variance revealed significant interactions. Post hoc 2-way analyses of variance showed significant group by cognitive task difficulty for anterior-posterior (P < .001), medial-lateral (P = .003), and overall stability indices (P < .001) on a stiffness level of 5 with eyes closed. At this level, there were significant differences between single- and dual-task conditions for anterior-posterior (P < .001), medial-lateral (P = .02), and overall stability indices (P < .001) only in the chronic low back pain group. Also, at the most difficult postural conditions, participants with chronic low back pain increased their error ratio (P = .002), whereas matched asymptomatic individuals increased their reaction time (P < .01) of the auditory Stroop test.

Conclusion: Postural task performance is attenuated by cognitive loading at a moderate level of postural task difficulty. Therefore, to observe the effect of attentional demands of postural control, task difficulty should be considered.
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http://dx.doi.org/10.1016/j.jmpt.2014.02.003DOI Listing
December 2014

Reliability, validity, and responsiveness of the Persian version of the rheumatoid and arthritis outcome score (RAOS) in patients with rheumatoid arthritis.

Clin Rheumatol 2015 Jan 8;34(1):35-42. Epub 2014 Feb 8.

Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran,

The aims of this study were to cross-culturally translate the original rheumatoid and arthritis outcome score (RAOS) into Persian and evaluate its reliability, validity, and responsiveness in a group of patients with rheumatoid arthritis (RA). The questionnaire was translated through a standard forward-backward translation. A sample of 103 patients was asked to complete the Persian RAOS, the Short Form-36 (SF-36), and the arthritis impact measurement scale-short form (AIMS2-SF). To determine test-retest reliability, the Persian RAOS was readministered to a sample of 50 patients, 3-6 days after the first visit. To evaluate responsiveness, 50 patients completed the Persian RAOS at baseline and at the end of a pharmacological intervention. Test-retest reliability and internal consistency were assessed using intraclass correlation coefficient (ICC) and Cronbach's alpha, respectively. Construct validity was assessed by comparing the results of the RAOS with the Persian SF-36 and AIMS2-SF using Spearman's correlation coefficient. Responsiveness was assessed by the calculation of effect size (ES) and standardized response means (SRM). The acceptable level of ICC > 0.70 and Cronbach's alpha > 0.70 were obtained for the most RAOS subscales. As expected, moderate to strong correlations were observed between subscales of the RAOS and the SF-36/AIMS2-SF intended to measure similar constructs. The ES range of 0.18 to 0.51 and the SRM range of 0.25 to 0.91 were obtained for the RAOS subscales. In conclusion, the Persian RAOS is a reliable, valid, and responsive outcome measure for patients with RA suffering from arthritis in the lower limb joints.
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http://dx.doi.org/10.1007/s10067-014-2515-4DOI Listing
January 2015

Comparison of functional outcome measures after ACL reconstruction in competitive soccer players: a randomized trial.

J Bone Joint Surg Am 2013 Jul;95(14):1271-7

Department of Physical Therapy, University of Social Welfare and Rehabilitation Sciences, Koodakyar Street, Daneshjou Boulevard, Evin, Tehran, Iran.

Background: The choice of graft for anterior cruciate ligament (ACL) reconstruction remains controversial. Although many outcome studies comparing bone-patellar tendon-bone and semitendinosus and gracilis tendon grafts have been performed, most have not included tests of functional outcomes that challenge the graft. The objective of the current study was to compare the functional performances of soccer players after ACL reconstruction that was performed with either a bone-patellar tendon-bone or a semitendinosus and gracilis tendon graft.

Methods: Forty-two soccer players with unilateral ACL injury were prospectively randomized to a bone-patellar tendon-bone group (BPTB group; twenty-one subjects) or a semitendinosus and gracilis tendon group (STG group; twenty-one subjects) and followed a rehabilitation protocol. At the time of return to sports, the patients were asked to execute strength, hop, and jump tests and the results were compared between the groups. Twenty-one healthy athletes were recruited as the control group to evaluate their performance of the same tests.

Results: The limbs with the ACL reconstruction in the STG group had greater values for quadriceps torque as well as on the triple-hop, crossover-hop, and jump-landing test (p < 0.01), but the STG and BPTB groups showed similar results in terms of hamstrings peak torque and the results of two other hop tests (p > 0.05). Moreover, the subjects with ACL reconstruction had significantly lower values with regard to quadriceps and hamstrings peak torques and the results of the hop and jump tests compared with the healthy athletes (p < 0.01).

Conclusions: At the time of return to sports, the STG group had better performance in terms of quadriceps strength and the results of the triple-hop, crossover-hop, and jump-landing tests compared with the BPTB group. Compared with controls, soccer players who had undergone ACL reconstruction had less quadriceps and hamstrings strength and inferior hop performance and jump-landing strategy.
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http://dx.doi.org/10.2106/JBJS.L.00724DOI Listing
July 2013

Cross-cultural validation of the Falls Efficacy Scale International (FES-I) using self-report and interview-based questionnaires among Persian-speaking elderly adults.

Arch Gerontol Geriatr 2013 Nov-Dec;57(3):339-44. Epub 2013 Jul 4.

Department of Physical Therapy, University of Social Welfare & Rehabilitation Sciences, Tehran, Iran.

FES-I has been designed to assess fear of falling (FoF). The purpose of this study was to establish the Persian-language version of the FES-I and to assess its psychometric properties under different modes of administration: self-report and interview-based. Participants included 191 elderly people aged over 60 who were mostly community dwelling. With an interval of 14 days, 97 volunteers completed the questionnaire in the retest session. To evaluate the construct validity, we assessed the ability of the FES-I to discriminate people based on gender, level of education, number of falls and FoF. The correlation with the Short Form of Health Survey (SF-36), Timed Up and Go (TUG) and Functional Reach Test (FRT) was also determined to test validity. Internal consistency was excellent in both self-report (0.93) and interview (0.92) versions. All intra-class correlations (ICCs) were above 0.70 with the highest reliability obtained for the condition where the interview based FES-I was used in both test and retest sessions. The strength of correlation between the FES-I and TUG varied based on mode of administration: moderate for interview and high for self-report mode. The FES-I had a higher correlation with the SF-36 subscales of physical health than subscales of mental health. The FES-I had the ability to discriminate the participants based on gender, educational level, and number of falls and FoF. In conclusion, both interview and self-report versions of the FES-I demonstrated acceptable measurement properties to assess FoF in Iranian elderly persons.
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http://dx.doi.org/10.1016/j.archger.2013.06.005DOI Listing
April 2014

Effect of soft and semirigid ankle orthoses on Star Excursion Balance Test performance in patients with functional ankle instability.

J Sci Med Sport 2014 Jul 28;17(4):430-3. Epub 2013 Jun 28.

Musculoskeletal Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Objectives: To evaluate the effect of soft and semirigid ankle orthoses on dynamic balance assessed using Star Excursion Balance Test in patients with functional ankle instability compared with healthy individuals.

Design: Non-experimental, observational study with multiple-factor design, including group (functional ankle instability and healthy) as the between-subjects factor and orthotics condition (no orthosis, soft orthosis and semirigid orthosis) as the within-subjects factor.

Methods: Sixteen unilateral functional ankle instability patients and a group of 16 healthy control individuals, matched for age, height and weight, participated in the study. Dynamic balance was tested with and without wearing ankle orthosis. Reach distance of participants in 3 bracing conditions were measured in anteromedial, medial and posteromedial directions of Star Excursion Balance Test. Average of 3 trials in 3 measured directions, normalized to leg length of each participant, was used for statistical analysis.

Results: There were no differences among orthotics conditions in healthy people. However, normalized reach distance increased from no-orthosis to semirigid to soft orthoses in FAI patients. Differences were significant between soft and no-orthosis (13% in anteromedial, 14% in medial and 15% in posteromedial direction p=0.01) and between semirigid and no-orthosis (10% in anteromedial, 8.5% in medial and 8.5% in posteromedial direction, p=0.01) conditions in all 3 measured directions. The difference between soft and semirigid orthoses was significant (6% difference, p<0.05) only in PM direction.

Conclusions: Ankle orthoses improve reach distance in functional ankle instability patients in various reach directions. Soft orthosis has a more pronounced effect on dynamic balance, especially in posteromedial direction, compared with semirigid orthosis.
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http://dx.doi.org/10.1016/j.jsams.2013.05.017DOI Listing
July 2014

The eccentric torque production capacity of the ankle, knee, and hip muscle groups in patients with unilateral chronic ankle instability.

Asian J Sports Med 2013 Jun 27;4(2):144-52. Epub 2013 Feb 27.

Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Purpose: The aim of this study was to investigate eccentric torque production capacity of the ankle, knee and hip muscle groups in patients with unilateral chronic ankle instability (CAI) as compared to healthy matched controls.

Methods: In this case-control study, 40 participants (20 with CAI and 20 controls) were recruited based on convenient non-probability sampling. The average peak torque to body weight (APT/BW) ratio of reciprocal eccentric contraction of ankle dorsi flexor/plantar flexor, ankle evertor/invertor, knee flexor/extensor, hip flexor/extensor and hip abductor/adductor was determined using an isokinetic dynamometer. All subjects participated in two separate sessions with a rest interval of 48 to 72 hours. In each testing session, the torque production capacity of the ankle, knee, and hip muscle groups of only one lower limb was measured. At first, 3 repetitions of maximal eccentric-eccentric contraction were performed for the reciprocal muscles of a joint in a given movement direction. Then, the same procedure of practice and testing trials was repeated for the next randomly-ordered muscle group or joint of the same limb.

Results: There was no significant interaction of group (CAI and healthy controls) by limb (injured and non-injured) for any muscle groups. Main effect of limb was not significant. Main effect of group was only significant for eccentric torque production capacity of ankle dorsi flexor and hip flexor muscle groups. The APT/BW ratio of these muscles was significantly lower in the CAI group than the healthy controls (P<0.05).

Conclusion: CAI is associated with eccentric strength deficit of ankle dorsi flexor and hip flexor muscles as indicated by reduction in torque production capacity of these muscles compared to healthy controls. This strength deficit appeared to exist in both the injured and non-injured limbs of the patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3690735PMC
http://dx.doi.org/10.5812/asjsm.34515DOI Listing
June 2013

A systematic review of postural control during single-leg stance in patients with untreated anterior cruciate ligament injury.

Knee Surg Sports Traumatol Arthrosc 2014 Jul 5;22(7):1491-504. Epub 2013 May 5.

Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Purpose: The aim of this review was to determine whether postural control is impaired in patients with anterior cruciate ligament (ACL) injury as compared to healthy controls.

Methods: The relevant papers were retrieved through electronic databases including PubMed, EMBASE, Web of Science, and Sport Discus followed by hand search and contact with the authors. Studies that evaluated static postural control during single-leg stance without applying external perturbations were included. Also, the patients should not have undergone ACL reconstruction or any surgical repair on the injured knee.

Results: In total, 12 studies were selected for full review. The included studies showed larger postural sway amplitudes or velocities during single-leg stance on the injured leg and the uninjured leg when compared to healthy controls with medium to large effect size. Also, no significant difference was found between the injured and uninjured legs of ACL-injured patients during eyes open condition in all studies supported by small effect size. However, the within-group difference was found to be significant during eyes closed condition, with injured leg displaying larger sway.

Conclusions: The present review indicates that postural control is impaired in both legs, especially injured leg. The result of within-group difference in eyes open condition confirms bilateral deficit of postural control. However, the within-group difference during eyes closed condition indicates again that ACL injury affects the injured leg more than the uninjured leg. In designing rehabilitation protocols, clinicians should consider training postural control of not just the injured but also the uninjured leg.
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http://dx.doi.org/10.1007/s00167-013-2501-4DOI Listing
July 2014

Intrasession and intersession reliability of postural control in participants with and without nonspecific low back pain using the Biodex Balance System.

J Manipulative Physiol Ther 2013 Feb;36(2):111-8

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

Objective: The purpose of this study was to evaluate the reliability of the Biodex Balance System (BBS) (Biodex Medical Systems, Shirley, NY) in chronic low back pain (CLBP) patients and healthy individuals in various conditions of postural and cognitive difficulty.

Methods: In this methodological study, using the BBS, dynamic balance of 15 CLBP patients and 15 healthy matched individuals was assessed during bilateral stance in combined conditions of visual feedback (eyes open and eyes closed) and platform stability (levels 5 and 3), either isolated or concurrent with performing cognitive task (auditory Stroop task). The Overall stability index, anterior-posterior stability index, and medial-lateral stability index, provided by BBS as measures of postural performance, were recorded. Intraclass correlation coefficient (ICC), standard error of measurement, and coefficient of variation were used to determine intersession and intrasession reliability of postural and cognitive measures.

Results: Biodex Balance System stability indices were more reliable in the CLBP (compared with healthy) group. The intersession ICCs in CLBP group for anterior-posterior stability index ranged from 0.60 to 0.88, for medial-lateral stability index from 0.64 to 0.94, and for OASI from 0.63 to 0.91. The intersession ICCs in healthy group for anterior-posterior stability index ranged from 0.42 to 0.86, for medial-lateral stability index from 0.56 to 0.89, and for OASI from 0.54 to 0.84. Biodex Balance System stability indices were more reliable in eyes-closed (compared with eyes-open) condition and platform stability level 5 (compared with level 3).

Conclusion: Biodex Balance System stability indices appear to be reliable measures of postural control in the CLBP patients especially in more challenging conditions, such as when standing with eyes closed.
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http://dx.doi.org/10.1016/j.jmpt.2012.12.005DOI Listing
February 2013

Validation of the Persian version of Functional Index Questionnaire (FIQ) and Modified FIQ in patients with patellofemoral pain syndrome.

Physiother Theory Pract 2013 Oct 30;29(7):521-30. Epub 2013 Jan 30.

Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

The aim of this investigation was to culturally translate and validate the Functional Index Questionnaire (FIQ) and Modified FIQ (MFIQ) in patients with patellofemoral pain syndrome (PFPS). A sample of 100 patients with PFPS completed the FIQ and MFIQ, and Short-Form 36 (SF-36) Health Survey in the first session. The FIQ and MFIQ were re-administered to a sample of 47 patients to evaluate test-retest reliability. Test-retest reliability and internal consistency were evaluated by the intraclass correlation coefficient (ICC) and Cronbach's alpha coefficient, respectively. Corrected item-total correlations and construct validity were assessed by Spearman's rank correlation. Factor analysis was performed on all items of the Persian FIQ and MFIQ to determine the number of underlying factors and the items which load on each factor. An acceptable level of test-retest reliability (ICC = 0.84, 0.85) and internal consistency (Cronbach's alpha = 0.79, 0.82) was obtained for both the Persian FIQ and MFIQ, respectively. Item-total correlations were greater than 0.40 for all but two questions of the Persian FIQ and all but four questions of the Persian MFIQ. A total of two factors were detected for each questionnaire. There were moderate to low correlations between the Persian FIQ/MFIQ and SF-36. Persian FIQ and MFIQ are two reliable and valid outcome measures of functional limitation and it seems that they are suitable for use in clinical practice of patients with chronic PFPS.
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http://dx.doi.org/10.3109/09593985.2012.761308DOI Listing
October 2013

The Persian version of Community Integration Questionnaire in persons with multiple sclerosis: translation, reliability, validity, and factor analysis.

Disabil Rehabil 2013 Aug 21;35(17):1453-9. Epub 2013 Jan 21.

Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Purpose: To culturally translate and validate the Community Integration Questionnaire (CIQ) in persons with multiple sclerosis (MS).

Methods: After a forward-backward translation, 105 persons with MS completed the Persian versions of the CIQ and MS Quality of Life (MSQOL) questionnaires in the first visit. The CIQ was re-administered to a sample of 45 persons with MS 7-10 days after the first session. Test-retest reliability and internal consistency were assessed using intraclass correlation coefficient (ICC) and Cronbach's α coefficient, respectively. Construct validity was assessed by measuring associations between subscales of the Persian CIQ (including Home Integration (HI), Social Integration (SI), and Productivity (P)) and MSQOL (including Physical and Mental Components). Dimensionality was assessed through two methods of corrected item-subscale correlation and factor analysis.

Results: The acceptable level of test-retest reliability (ICC ≥0.70) was obtained for the Persian CIQ. However, Cronbach's α coefficient of ≥0.70 was only seen for the HI. The correlations between the Persian CIQ and the Physical MSQOL were higher than those of Persian CIQ and the Mental MSQOL. The corrected item-subscale Spearman's correlation coefficient of 0.40 was exceeded by most items of the HI and 2 items of P. A total of four factors were detected and similar to the results of item-subscale correlation, the most variability was seen for the items of SI which loaded on different factors.

Conclusions: Persian CIQ seems to be a reliable and valid instrument for monitoring the level of community integration following rehabilitation in persons with MS. Some modifications need to be made in the SI of the Persian CIQ to improve extraction of information regarding community integration of persons with MS.
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http://dx.doi.org/10.3109/09638288.2012.741653DOI Listing
August 2013

Intra and intersession reliability of a postural control protocol in athletes with and without anterior cruciate ligament reconstruction: a dual-task paradigm.

Int J Sports Phys Ther 2012 Dec;7(6):627-36

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

Background: Quantification of dynamic balance is essential to assess a patient's level of injury or ability to function so that a proper plan of care may commence. In spite of comprehensive utilization of dual-tasking in balance assessment protocols, a lack of sufficient reliability data is apparent.

Purpose: The purpose of the present study was to determine the intra- and inter-session reliability of dynamic balance measures obtained using the Biodex Balance System® (BBS) for a group of athletes who had undergone anterior cruciate ligament reconstruction (ACLR) and a matched control group without ACLR, while using a dual-task paradigm.

Methods: Single-limb postural stability was assessed in 15 athletes who had undergone ACLR and 15 healthy matched controls. The outcome variables included measures of both postural and cognitive performance. For measuring postural performance, the overall stability index (OSI), anterior-posterior stability index (APSI), and medial-lateral stability index (MLSI), were recorded. Cognitive performance was evaluated by measuring error ratio and average reaction time. Subjects faced 4 postural task difficulty levels (platform stabilities of 8 and 6 with eyes open and closed), and 2 cognitive task difficulty levels (with or without auditory Stroop task). During dual task conditions (conditions with Stroop task), error ratio and average reaction time were calculated.

Results: Regarding intrasession reliability, ICC values of test session were higher for MLSI [ACL-R group (0.83-0.95), control group (0.71-0.95)] compared to OSI [ACL-R group (0.80-0.92), control group (0.67-0.95)] and APSI [ACL-R group (0.73-0.90), control group (0.62-0.90)]. Furthermore, ICC values of first test session were higher in reaction time [ACL-R group (0.92-0.95), control group (0.80-0.92)] than error ratio [ACL-R group (0.72-0.88), control group (0.61-0.83)]. ICC values of retest session were higher for MLSI [ACL-R group (0.83-0.94), control group (0.87-0.93)] than OSI [ACL-R group (0.81-0.91), control group (0.83-0.93)] and APSI [ACL-R group (0.73-0.90), control group (0.53-0.90)]. Moreover, ICC values of retest session were higher in reaction time [ACL-R group (0.89-0.98), control group (0.80-0.92)] equated with error ratio [ACL-R group (0.73-0.87), control group (0.57-0.79)]. With respect to intersession reliability, ICC values were higher for MLSI [ACL-R group (0.72-0.96), control group (0.75-0.92)] than OSI [ACL-R group (0.55-0.91), control group (0.64-0.87)] and APSI [ACL-R group (0.55-0.79), control group (0.46-0.89)]. Additionally, ICC values were higher in reaction time [ACL-R group (0.87-0.95), control group (0.68-0.81)] in contrast to error ratio [ACL-R group (0.42-0.64), control group (0.54-0.74)].

Conclusion: Biodex Balance System® measures of postural stability demonstrated moderate to high reliability in athletes with and without ACLR during dual-tasking. Results of the current study indicated that assessment of postural and cognitive performance in athletes with ACLR may be reliably incorporated into the evaluation of functional activity.

Level Of Evidence: 2b.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3537456PMC
December 2012

Effect of expertise in shooting and Taekwondo on bipedal and unipedal postural control isolated or concurrent with a reaction-time task.

Gait Posture 2013 Jun 11;38(2):226-30. Epub 2012 Dec 11.

Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

It was hypothesized that training in 'static balance' or 'dynamic balance' sports has differential effects on postural control and its attention demands during quiet standing. In order to test this hypothesis, two groups of female athletes practicing shooting, as a 'static balance' sport, and Taekwondo, as a 'dynamic balance' sport, and a control group of non-physically active females voluntarily participated in this study. Postural control was assessed during bipedal and unipedal stance with and without performing a Go/No-go reaction time task. Visual and/or support surface conditions were manipulated in bipedal and unipedal stances in order to modify postural difficulty. Mixed model analysis of variance was used to determine the effects of dual tasking on postural and cognitive performance. Similar pattern of results were found in bipedal and unipedal stances, with Taekwondo practitioners displaying larger sway, shooters displaying lower sway and non-athletes displaying sway characteristics intermediate to Taekwondo and shooting athletes. Larger effect was found in bipedal stance. Single to dual-task comparison of postural control showed no significant effect of mental task on sway velocity in shooters, indicating less cognitive effort invested in balance control during bipedal stance. We suggest that expertise in shooting has a more pronounced effect on decreased sway in static balance conditions. Furthermore, shooters invest less attention in postures that are more specific to their training, i.e. bipedal stance.
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http://dx.doi.org/10.1016/j.gaitpost.2012.11.016DOI Listing
June 2013

Low back pain and postural sway during quiet standing with and without sensory manipulation: a systematic review.

Gait Posture 2013 Jan 15;37(1):12-22. Epub 2012 Jul 15.

Musculoskeletal Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

A previous review concluded that postural sway is increased in patients with low back pain (LBP). However, more detailed analysis of the literature shows that postural deficit may be dependent on experimental conditions in which patients with LBP have been assessed. The research question to be answered in this review was: "Is there any difference in postural sway between subjects with and without LBP across several sensory manipulation conditions?". A literature search in Pubmed, Scopus, Embase and PsychInfo was performed followed by hand search and contact with authors. Studies investigating postural sway during bipedal stance without applying external forces in patients with specific and non-specific LBP compared to healthy controls were included. Twenty three articles fulfilled the eligibility criteria. Most studies reported an increased postural sway in LBP, or no effect of LBP on postural sway. In a minority of studies, a decreased sway was found in LBP patients. There were no systematic differences between studies finding an effect and those reporting no effect of LBP. The proportion of studies finding between-group differences did not increase with increased complexity of sensory manipulations. Potential factors that may have caused inconsistencies in the literature are discussed in this systematic review.
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http://dx.doi.org/10.1016/j.gaitpost.2012.06.013DOI Listing
January 2013

Persian translation and validation of the Kujala Patellofemoral Scale in patients with patellofemoral pain syndrome.

Disabil Rehabil 2012 27;34(26):2259-63. Epub 2012 May 27.

Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Purpose: To culturally translate and validate the Persian version of Kujala Patellofemoral Scale (KPS) and evaluate the test-retest reliability, internal consistency, construct validity and ceiling or floor effects of this instrument in patients with patellofemoral pain syndrome (PFPS).

Method: After standard forward and backward translations, 100 patients with PFPS completed the Persian versions of the KPS and Short-Form 36 Health Survey (SF-36) in the first visit. With time interval of 2-3 days after the first visit, 47 patients filled out the KPS in the second visit. Test-retest reliability and internal consistency were assessed using intraclass correlation coefficient (ICC(2,1)) with 95% confidence interval (95% CI) and Cronbach's α coefficient, respectively. The Spearman's rank correlation (r(s)) was used to assess the correlations between the Persian KPS and SF-36 subscales.

Results: The acceptable level of ICC >0.70 (ICC = 0.96, 95% CI = 0.93-0.98) and Cronbach's α coefficient >0.70 (α = 0.81) was obtained for the Persian KPS. There were low to moderate correlations (r(s) = 0.25-0.60, p < .01) between the Persian KPS and Persian SF-36 subscales of mental and physical health components. However, correlations between the Persian KPS and SF-36 physical components were higher than correlations between the Persian KPS and SF-36 mental components. No ceiling and floor effects were seen for the Persian KPS.

Conclusions: The Persian version of KPS is a reliable and valid outcome measure of disability and seems to be a suitable instrument for use in clinical practice of Iranian patients with chronic PFPS.
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http://dx.doi.org/10.3109/09638288.2012.683480DOI Listing
December 2012

The Persian version of the Berg Balance Scale: inter and intra-rater reliability and construct validity in elderly adults.

Disabil Rehabil 2012 2;34(20):1695-8. Epub 2012 Mar 2.

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

Purpose: As a well-known measure for quantifying functional mobility in elderly persons, Berg Balance Scale (BBS) was used in the present study to evaluate its psychometric properties among a sample of 106 elderly individuals speaking Persian language.

Method: After forward-backward translation process, videotapes were recorded from all participants while performing 14 tasks of the BBS. The volunteers were also asked to perform the Timed Up and Go (TUG) test at the same session. To determine inter and intra-rater reliability, the videotapes were viewed by two experienced therapists while one of the raters assessed the videotaped performance of the subjects on a second occasion.

Results: Intraclass correlation coefficients (95% confidence interval) of 0.93 (0.87 0.96) and 0.95 (0.92 0.97) were obtained for inter and intra-rater reliability, respectively. Cronbach's alpha was 0.62 which is marginally lower than the cut-off point of 0.70. Furthermore, there were no ceiling and floor effects for the Persian version. In terms of construct validity, the BBS had a negative and strong correlation with the TUG (r = -0.74, p < 0.001).

Conclusions: Acceptable levels of intra and inter-rater reliability with a moderate internal consistency and high validity were demonstrated for the Persian version of BBS.
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http://dx.doi.org/10.3109/09638288.2012.660604DOI Listing
October 2012

Static and dynamic postural control in competitive athletes after anterior cruciate ligament reconstruction and controls.

Knee Surg Sports Traumatol Arthrosc 2012 Aug 29;20(8):1603-10. Epub 2011 Nov 29.

Department of Physical Therapy, University of Social Welfare and Rehabilitation Sciences, Koodakyar St, Daneshjou Blvd, Evin, Tehran, Iran.

Purpose: To evaluate the test-retest reliability and compare the static and dynamic postural control values in competitive athletes following anterior cruciate ligament (ACL) reconstruction and controls.

Methods: Thirty athletes, 8.4 ± 1.8 months after ACL reconstruction, and thirty healthy matched controls were asked to execute single-leg stance and single-legged drop jump tests onto a force plate. Amplitude and velocity in anteroposterior and mediolateral directions, and mean total velocity were measured for static evaluation. Peak vertical ground reaction force (PVGRF) during landing and takeoff and loading rate were measured for dynamic evaluation. To evaluate test-retest reliability, 15 participants of each group repeated the tests 6-8 days after the first session. Mixed model of analysis of variance was used to determine differences between the involved, uninvolved, and control limbs. The test-retest reliability was measured using intraclass correlation coefficient and standard error of measurement.

Results: Greater postural sway has been observed in the operated leg of ACL-reconstructed athletes compared with the non-operated side (P < 0.01) and the matched limb of the control group (P < 0.01). During landing, PVGRF and loading rate on the uninvolved limb of the athletes who had undergone ACL reconstruction were greater in comparison with those of the control group (P < 0.001). Both static and dynamic postural measures have high test-retest reliability, ranging from 0.73 to 0.88.

Conclusions: Static and dynamic postural measures are reliable tests to evaluate functional performance of athletes following ACL reconstruction. Eight months postsurgery, competitive athletes still demonstrated postural asymmetries, compared to matched controls, which might result in their susceptibility to future ACL injury.

Level Of Evidence: Prognostic study, case-control, Level III.
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http://dx.doi.org/10.1007/s00167-011-1806-4DOI Listing
August 2012

Reliability of force-platform measures of postural sway and expertise-related differences.

J Sport Rehabil 2011 Nov;20(4):442-56

Science and Research Branch, Islamic Azad University, Tehran, Iran.

Context: Although reliability is a population-specific property, few studies have investigated the measurement error associated with force-platform parameters in athletic populations.

Objective: To investigate the skill-related differences between athletes and nonathletes in reliability of center-of-pressure (COP) summary measures under eyes-open (EO) and eyes-closed (EC) conditions.

Design: Test-retest reliability study.

Setting: COP was recorded during double-leg quiet standing on a Kistler force platform before and after a fatiguing treadmill exercise, with EO and EC.

Participants: 31 male participants including 15 athletes practiced in karate and 16 nonathletes.

Main Outcome Measures: Standard deviation (SD) of amplitude, phase-plane portrait, SD of velocity, mean total velocity, and area were calculated from 30-s COP data. Intraclass correlation coefficient (ICC), standard error of measurement, and coefficient of variation (CV) were used as estimates of reliability and precision.

Results: Higher ICCs were found for COP measures in the athlete (compared with the nonathlete) group, postfatigued (compared with prefatigued) condition, and EC (compared with EO) tests. CVs smaller than 15% were obtained for most of the COP measures. SD of velocity in the anteroposterior direction showed the highest reliability in most conditions.

Conclusions: Tests with EC and to a lesser extent tests performed in the athlete group and in the postfatigued condition showed better reliability.
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http://dx.doi.org/10.1123/jsr.20.4.442DOI Listing
November 2011

The effects of cognitive loading on balance control in patients with multiple sclerosis.

Gait Posture 2011 Oct 28;34(4):479-84. Epub 2011 Jul 28.

Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

The aim of this study was to compare the effects of concurrent cognitive task (silent backward counting) on balance performance between two groups of multiple sclerosis (MS) (n=23) and healthy (n=23) participates. Three levels of postural difficulty were studied on a force platform, i.e. rigid surface with eyes open, rigid surface with eyes closed, and foam surface with eyes closed. A mixed model analysis of variance showed that under difficult sensory condition of foam surface with eyes closed, execution of concurrent cognitive task caused a significant decrement in variability of sway velocity in anteroposterior direction for the patient group (P<0.01) while this was not the case for healthy participants (P=0.22). Also, the variability of sway velocity in mediolateral direction was significantly decreased during concurrent execution of cognitive task in patient group (P<0.01) and not in healthy participants (P=0.39). Furthermore, in contrast to single tasking, dual tasking had the ability to discriminate between the 2 groups in all conditions of postural difficulty. In conclusion, findings of variability in sway velocity seem to confirm the different response to cognitive loading between two groups of MS and healthy participants.
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http://dx.doi.org/10.1016/j.gaitpost.2011.06.023DOI Listing
October 2011

Reliability and validity of the Tegner and Marx activity rating scales in Iranian patients with anterior cruciate ligament injury.

Disabil Rehabil 2011 14;33(23-24):2305-10. Epub 2011 Apr 14.

Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Purpose: The aims of this study were to culturally translate and validate the Persian version of Tegner and Marx activity rating scales and to investigate their psychometric properties in a sample of patients (n = 100) with anterior cruciate ligament (ACL) injury.

Method: Four questionnaires were completed by the respondents: Tegner and Marx activity scales, Knee injury and Osteoarthritis Outcome Score (KOOS) and Short-Form 12 Health Survey (SF-12). The Tegner and Marx were re-administered to 45 patients in the retest session, with time interval of 2-6 days between the two sessions. Test-retest reliability and internal consistency were assessed using intra-class correlation coefficient (ICC) and Cronbach's alpha, respectively. To evaluate construct validity of Tegner and Marx compared to similar and dissimilar concepts of KOOS and SF-12, the Spearman's rank correlation was used.

Results: Both Tegner and Marx activity scales have a high ICC level. The minimum Cronbach's alpha level of 0.70 was exceeded by Marx scale. In terms of construct validity, most of a priori hypotheses were confirmed.

Conclusions: The Persian version of Tegner and Marx seems to be suitable for Iranian patients with ACL injury. Future studies are needed to investigate the psychometric properties of these questionnaires for Iranian patients with different knee problems.
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http://dx.doi.org/10.3109/09638288.2011.570409DOI Listing
March 2012