Publications by authors named "Mohammad Jafar Shaterzadeh Yazdi"

22 Publications

  • Page 1 of 1

Effects of Virtual Reality vs Conventional Balance Training on Balance and Falls in People With Multiple Sclerosis: A Randomized Controlled Trial.

Arch Phys Med Rehabil 2021 02 5;102(2):290-299. Epub 2020 Nov 5.

Department of Neurology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Objective: To assess the efficacy of virtual reality (VR)-based vs conventional balance training on the improvement of balance and reduction of falls in people with multiple sclerosis (PwMS).

Design: Single-blinded, randomized, controlled trial.

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

Participants: PwMS (N=39), randomized into VR (n=19) and control (n=20) groups.

Intervention: The VR group performed exergames using Kinect, while the control group accomplished conventional balance exercises. Both groups received 18 training sessions for 6 weeks.

Main Outcome Measures: Limits of stability, timed Up and Go (TUG) test, and 10-m walk tests with and without cognitive task and their dual-task costs (DTCs), Berg Balance Scale, Multiple Sclerosis Walking Scale-12, Fall Efficacy Scale-International, Activities-specific Balance Confidence Scale, and fall history were obtained pre- and post intervention and after a 3-month follow-up.

Results: At both post intervention and follow-up, TUG and DTCs on the TUG were significantly lower and the 10-m walk was significantly higher in the VR group. At follow-up, reaction time and the number of falls demonstrated significant differences favoring the VR group, whereas the directional control revealed significant difference in favor of the control group (P<.05). The other outcomes showed no statistically significant difference at post intervention or follow-up.

Conclusions: Both the VR-based and conventional balance exercises improved balance and mobility in PwMS, while each acted better in improving certain aspects. VR-based training was more efficacious in enhancing cognitive-motor function and reducing falls, whereas conventional exercises led to better directional control. Further studies are needed to confirm the effectiveness of recruiting VR-based exercises in clinical settings.
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http://dx.doi.org/10.1016/j.apmr.2020.09.395DOI Listing
February 2021

Responsiveness and clinically meaningful changes for the Persian versions of the multiple sclerosis walking scale-12 and the modified fatigue impact scale following balance and gait rehabilitation in people with multiple sclerosis.

Physiother Theory Pract 2020 May 20:1-7. Epub 2020 May 20.

Department of Neurology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

: The Multiple sclerosis walking scale-12 (MSWS-12) and the Modified Fatigue Impact Scale (MFIS) are two popular outcome measures applied widely for assessing self-perceived walking ability and fatigue in people with multiple sclerosis (PwMS). The present study aimed to examine responsiveness and clinically meaningful changes for the Persian versions of the MSWS-12 and the MFIS following balance and gait rehabilitation in PwMS.: Fifty-eight PwMS completed the Persian versions of the MSWS-12 and the MFIS before and after 4 weeks of balance and gait rehabilitation. Also, a 7-point global rating scale as an external criterion of change was completed at the post-intervention evaluation. The area under the receiver operating characteristics curve (AUC) and the correlation analysis were used to assess the responsiveness. In addition, the minimally clinically important change (MCIC) was measured to determine clinically meaningful changes following rehabilitation.: The AUC values for the Persian MSWS-12 and MFIS were 0.74 and 0.73, respectively. There were good to excellent correlations between the global rating scale of change and the Persian MSWS-12 (Gamma = 0.77) also MFIS (Gamma = 0.80) change scores ( = .001). Moreover, the MCICs of 7.5 and 4 points were obtained for the Persian MSWS-12 and MFIS, respectively.: The Persian versions of the MSWS-12 and the MFIS were responsive outcome measures for monitoring changes in walking and fatigue after balance and gait rehabilitation in PwMS. The calculation of MCIC values would enhance the interpretation of changes in clinical and research settings.
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http://dx.doi.org/10.1080/09593985.2020.1762267DOI Listing
May 2020

The effect of transcranial direct current stimulation on balance in healthy young and older adults: A systematic review of the literature.

Neurophysiol Clin 2020 Apr 26;50(2):119-131. Epub 2020 Feb 26.

Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.

Various studies have investigated the effect of noninvasive brain stimulation methods such as transcranial direct stimulation (tDCS) on postural control in healthy young and older adults. However, the use of different treatment protocols and outcome measures makes it difficult to interpret the research results. This systematic review provides a comprehensive overview of the current literature on the effect of tDCS on postural control. Nine databases were searched for papers assessing the effect of tDCS on postural control in young healthy and/or older adults. The data of included studies were extracted and methodological quality examined using PEDro. Sixteen studies met the inclusion criteria. The results showed that anodal tDCS (a-tDCS) of primary motor cortex may improve dynamic balance in young healthy individuals. In older adults, a-tDCS of dorsolateral prefrontal cortex and cerebellum showed a positive effect on dual task and dynamic balance, respectively. In conclusion, tDCS may improve both static and dynamic balance in younger and older adults. However, due to lack of consensus in the results, caution is required when drawing conclusions with regards to these findings.
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http://dx.doi.org/10.1016/j.neucli.2020.01.006DOI Listing
April 2020

Examination of Lumbopelvic and Lower Extremity Movements in two Subgroups of People with Chronic Low Back Pain Based on the Movement System Impairment Model During a Stair Descending Task.

Ortop Traumatol Rehabil 2019 Jun;21(3):197-205

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

Background: Excessive and early lumbopelvic motion during functional tasks is associated with increased pain and symptoms in people with low back pain. The purpose of the current study was to compare lumbopelvic and lower extremity movements in two subgroups of chronic low back pain sufferers and healthy subjects during a stair descending task based on a movement system impairment model.

Material And Methods: A clinical examination was conducted to assign people with low back pain to movement system impairment-based subgroups. A control group included 18 healthy subjects, a lumbar Rotation with Flexion group included 12 subjects, and a lumbar Rotation with Extension group included 16 subjects. Differences in kinematics data between the groups were recorded during a stair descending task using a 7-camera 3-dimensional motion capture system.

Results: In the lumbar Rotation with Flexion group, the onset of lumbar movement occurred earlier than in the control group (p = 0.043). In the lumbar Rotation with Flexion group, axial and frontal plane rotation of the pelvis and lower extremity were significantly greater than in the control group. Mean differences between the lumbar Rotation with Extension and control group were minimal for the motion assessed.

Conclusion: Early and excessive lumbopelvic movement and more axial rotation in the lower extremities during a stair descending task were found in the lumbar Rotation with Flexion subgroup, which can be an important factor contributing to the development or persistence of low back pain in this group.
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http://dx.doi.org/10.5604/01.3001.0013.2933DOI Listing
June 2019

Clustering of patients with chronic low back pain in terms of physical and psychological factors: A cross-sectional study based on the STarT Back Screening Tool.

J Back Musculoskelet Rehabil 2020 ;33(4):581-587

Background: The STarT Back Screening Tool (SBT) is a multidimensional questionnaire consisting of physical and psychological factors which categorizes the patients in the low, medium or high risk subgroups.

Objective: To investigate the relationship between SBT-based subgrouping and clustering of patients with LBP using uni-dimensional psychological, clinical and physical examination measures.

Methods: One hundred and fifty-seven patients with chronic LBP completed the SBT and uni-dimensional psychological, disability and pain questionnaires. Physical impairments were evaluated through the Physical Impairment Index (PII). Hierarchical and K-means methods were used for cluster analysis. Between-clusters differences and the association between the clusters and SBT-based subgrouping were investigated.

Results: Three clusters were identified. The derived clusters were labeled severe, moderate and mild physical-psychological-distress clusters, because pain intensity, disability, psychological and physical factors were relatively high, moderate or low, respectively. Most of the patients in moderate and mild physical-psychological distress clusters were categorized as medium risk based on SBT. The mean difference for the PII was higher than that of psychological factors between moderate and mild physical-psychological-distress clusters.

Conclusions: Patients in low and high risk subgroups of SBT were sufficiently differentiated, but patients in a medium risk subgroup had a different profile based on PII. Including additional physical factors in the SBT may be required to better differentiate among patients.
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http://dx.doi.org/10.3233/BMR-181484DOI Listing
December 2020

Impaired local dynamic stability during treadmill walking predicts future falls in patients with multiple sclerosis: A prospective cohort study.

Clin Biomech (Bristol, Avon) 2019 07 9;67:197-201. Epub 2019 May 9.

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

Background: Falling is a significant problem in patients with multiple sclerosis (MS) and the majority of falls occur during dynamic activities. Recently, there have been evidences focusing on falls and local stability of walking based on dynamic system theory in the elderly as well as patients with cerebral concussion. However, in patient with MS, this relationship has not been fully investigated. The aim of this study was to investigate local stability of walking as a risk factor for falling in patients with MS.

Methods: Seventy patients were assessed while walking at their preferred speed on a treadmill under single and dual task conditions. A cognitive task (backward counting) was used to assess the importance of dual tasking to fall risk. Trunk kinematics were collected using a cluster marker over the level of T and a 7-camera motion capture system. To quantify local stability of walking, maximal finite-time Lyapunov exponent was calculated from a 12-dimensional state space reconstruction based on 3-dimensional trunk linear and angular velocity time series. Participants were classified as fallers (≥1) and non-fallers based on their prospective fall occurrence.

Findings: 30 (43%) participants recorded ≥1 falls and were classified as fallers. The results of multiple logistic regression analysis revealed that short-term local dynamic stability in the single task condition (P<0.05, odds ratio=2.214 (1.037-4.726)) was the significant fall predictor.

Interpretation: The results may indicate that the assessment of local stability of walking can identify patients who would benefit from gait retraining and fall prevention programs.
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http://dx.doi.org/10.1016/j.clinbiomech.2019.05.013DOI Listing
July 2019

Differences in timing and magnitude of lumbopelvic rotation during active and passive knee extension in sitting position in people with and without low back pain: A cross-sectional study.

Hum Mov Sci 2019 Apr 6;64:338-346. Epub 2019 Mar 6.

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

Repetitive lumbopelvic rotation (LPR) during active limb movements has been indicated as a factor that contributes to low back pain (LBP). Prior studies suggest that people with LBP demonstrate greater and earlier LPR during limb movements in prone. We examined timing and magnitude of LPR during sitting active knee extension in people with and without LBP. We also investigated differences of LPR during active and passive knee extension in LBP group. 38 men (mean age: 38.4)10.6) years) with chronic mechanical LBP and 38 matched healthy men (mean age: 36.6(8.4) years) were examined. Kinematic data were collected by motion capture system and analyzed using OpenSim software. The difference between the start time of knee extension and start time of LPR was calculated and was normalized to knee extension movement time. Maximum angular displacement for LPR was also calculated across time. People with LBP demonstrated earlier LPR during knee extension than healthy subjects (P < 0.01). There was, however, no difference in maximum LPR between groups. LBP group also demonstrated greater and earlier LPR during active than during passive knee extension (P < 0.01). Earlier LPR during limb movements in sitting may be related to LBP. Quadriceps muscle activity and inefficient trunk muscles activation may contribute to early LPR in LBP group. A greater understanding of the factors that may contribute to early LPR during daily activities can provide information to guide rehabilitation treatment for people with LBP.
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http://dx.doi.org/10.1016/j.humov.2019.02.012DOI Listing
April 2019

Responsiveness of a Persian version of Knee Injury and Osteoarthritis Outcome Score and Tegner activity scale in athletes with anterior cruciate ligament reconstruction following physiotherapy treatment.

Physiother Theory Pract 2020 Sep 23;36(9):1019-1026. Epub 2018 Nov 23.

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

Purpose: To evaluate the responsiveness and determine the minimal clinically important changes (MCICs), anchored by the patient response to a 7-point global rating scale, for Knee Injury and Osteoarthritis Outcome Score (KOOS), and Tegner activity scale in athletes undergoing physiotherapy treatment after anterior cruciate ligament reconstruction (ACL-R). Fifty-four patients undergoing physiotherapy completed the Persian versions of KOOS and Tegner scales at weeks 6 and 10 post ACL-R. The 7-point global rating of change was also completed at week 10. Responsiveness was calculated via receiver operating characteristic curve and correlation analysis. Acceptable responsiveness was reached by the KOOS sports and recreation subscale (Sport/Rec) (area under the curve (AUC) = 0.72; Gamma = 0.37) and Tegner scale (AUC = 0.75; Gamma = 0.59). The MCIC scores of KOOS subscales and Tegner scale were reported. Our findings demonstrated that the KOOS Sport/Rec subscale and Tegner scale have adequate responsiveness between weeks 6 and 10 of physiotherapy. Therefore, these scales should be used to evaluate the effects of physiotherapy treatment and the changes in activity levels in this population. The MCIC scores of the KOOS and Tegner scale can be used to detect changes significant to the patient while avoiding limitations of other methods.
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http://dx.doi.org/10.1080/09593985.2018.1548672DOI Listing
September 2020

Muscle Activity Pattern Dysfunction During Sit to Stand and Stand to Sit in the Movement System Impairment Subgroups of Low Back Pain.

Arch Phys Med Rehabil 2019 05 11;100(5):851-858. Epub 2018 Oct 11.

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

Objective: To investigate impairment in the activity pattern of some muscles involved in sit to stand (STD) and stand to sit (STS) among 2 low back pain (LBP) subgroups of the Movement System Impairment (MSI) model.

Design: Case-control study.

Setting: A university medical center.

Participants: Fifteen women without chronic LBP and 22 women with chronic LBP (N=37) in 2 subgroups (15 into the lumbar extension rotation (LER) and 7 into lumbar flexion rotation [LFR]) voluntarily participated in this study.

Interventions: Participants were asked to perform STD and STS at a preferred speed. Surface electromyography (EMG) were measured bilaterally from the internal oblique (IO), lumbar erector spine (ES), medial hamstring (MH), and lateral hamstring (LH) muscles.

Main Outcome Measures: Changes in mean and maximum amplitude, time to peak amplitude, duration of muscle activity, and bilateral asymmetry of these variables.

Results: During STD, bilateral asymmetry in mean amplitude of MH in the LER subgroup (P=.031) and bilateral asymmetry in duration of LH in the LFR subgroup (P=.026) were exhibited. Also, in this task reduced time to peak left MH activation were found in the LFR subgroup than 2 other groups (control; P=.028/LER; P=.004). During STS, increased left ES maximum amplitude were observed in the LFR subgroup than LER subgroup (P=.029). Also, reduced time to peak right ES (P=.035) and left LH (P=.038) activation in the LER subgroup than control subjects and reduced time to peak left LH activation in LFR subgroup than control subjects (P=.041) were observed during STS.

Conclusions: The differences between the 2 LBP subgroups may be a result of impairment in the activity pattern of some muscles during functional activity.
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http://dx.doi.org/10.1016/j.apmr.2018.08.190DOI Listing
May 2019

Relationship between functional balance and walking ability in individuals with chronic stroke.

J Phys Ther Sci 2018 Aug 24;30(8):993-996. Epub 2018 Jul 24.

Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Iran: Golestan St, Ahvaz, 6135733133, Iran.

[Purpose] The objective of this cross sectional study was to investigate the validity of Functional Ambulation Category in evaluating functional balance and identifying the relationship between balance impairment and functional ambulation in individuals with chronic stroke. [Participants and Methods] A total of 31 chronic stroke patients with first ever ischemic middle cerebral artery strokes, with no cognitive deficits were recruited. Participants had a mean age of 54.84 (SD=7.05) years and a time after stroke of 22.74 (SD=27.13) months. Community ambulation was determined by Functional Ambulation Category and functional balance was assessed by Berg Balance Scale. [Results] The mean Berg Balance Scale and the Functional Ambulation Category scores were 47.38 (SD=7.54) and 3.8 (SD=0.79), respectively. Correlation analysis revealed that balance impairment and ambulatory function was significantly positively correlated with each other (r=0.80). [Conclusion] The results shows that the Functional Ambulation Category is a valid tool in evaluating functional balance and suggest that functional balance may be an important goal for rehabilitation to achieve improvement in walking ability in people with chronic stroke.
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http://dx.doi.org/10.1589/jpts.30.993DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6110215PMC
August 2018

Examining the diagnostic accuracy of static postural stability measures in differentiating among knee osteoarthritis patients with mild and moderate to severe radiographic signs.

Gait Posture 2018 07 12;64:1-6. Epub 2018 May 12.

Department of Biostatistics and Epidemiology, Faculty of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Electronic address:

Background: Clinicians need a reliable and accurate tools that can best identify and classify balance impairments between mild and moderate to severe grades of knee osteoarthritis (OA).

Research Question: This study was designed to investigate the accuracy of postural measurements to discriminate between these two groups of knee OA.

Methods: A total of 130 patients with knee OA based on the Kellgren-Lawrence (KL) grading scale were categorized into 65 patients with mild (a KL grade≤ 2) and 65 patient with moderate to severe (a KL grade≥3) radiographic sign. Static postural control was assessed on the force plate in three conditions of double leg stance with open (DO) and closed eyes (DC) and single leg stance with open eyes (SO). The accuracy for static postural control parameters was determined by calculation of sensitivity, specificity, area under the Receiver Operating Characteristic (ROC) curve (AUC) and likelihood ratios (LRs).

Results: Our results showed that standard deviation (SD) of velocity in anterior-posterior (AP) direction had the highest sensitivity and specificity in conditions of DO and DC, respectively. ROC curve analysis indicated that measures of mean and SD velocity in medio-lateral (ML) direction in conditions of DO and DC had acceptable levels of accuracy (AUC > 0.70) in discriminating between the two groups of knee OA patients. Also, based on LR results, SD of velocity in AP direction had the best ability for ruling in and ruling out moderate to severe grade of knee OA patients in conditions of DC and DO, respectively.

Significance: Our findings provide evidence for selection of mean velocity and SD of velocity in identifying and discriminating static postural performance in patients with mild and moderate to severe grades of knee OA.
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http://dx.doi.org/10.1016/j.gaitpost.2018.04.049DOI Listing
July 2018

Predicting falls among patients with multiple sclerosis: Comparison of patient-reported outcomes and performance-based measures of lower extremity functions.

Mult Scler Relat Disord 2017 Oct 27;17:69-74. Epub 2017 Jun 27.

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

Background: Accurate fall screening tools are needed to identify those multiple sclerosis (MS) patients at high risk of falling. The present study aimed at determining the validity of a series of performance-based measures (PBMs) of lower extremity functions and patient-reported outcomes (PROs) in predicting falls in a sample of MS patients (n = 84), who were ambulatory independent.

Methods: Patients were assessed using the following PBMs: timed up and go (TUG), timed 25-foot walk (T25FW), cognitive T25FW, 2-min walk (2MW), and cognitive 2MW. Moreover, a series of valid and reliable PROs were filled in by participants including the activities-specific balance confidence (ABC), 12-item multiple sclerosis walking scale (MSWS-12), fall efficacy scale international (FES-I), and modified fatigue impact scale (MFIS). The dual task cost (DTC) of 2MW and T25FW tests were calculated as a percentage of change in parameters from single to dual task conditions. Participants were classified as none-fallers and fallers (⩾1) based on their prospective fall occurrence.

Results: In the present study, 41(49%) participants recorded ≥ 1 fall and were classified as fallers. The results of logistic regression analysis revealed that each individual test, except DTC of 2MW and T25FW, significantly predicted future falls. However, considering the area under the curves (AUCs), PROs were more accurate compared to PBMs. In addition, the results of multiple logistic regression with the first two factors extracted from principal component analysis revealed that both factor 1 (PROs) and factor 2 (PBMs) significantly predicted falls with a greater odds ratio (OR) for factor 1 (factor 1: P = <0.0001, OR = 63.41 (6.72-597.90)) than factor 2 (P <0.05, OR = 5.03 (1.33-18.99)).

Conclusions: The results of this study can be used by clinicians to identify and monitor potential fallers in MS patients.
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http://dx.doi.org/10.1016/j.msard.2017.06.014DOI Listing
October 2017

Diagnostic evaluation of dysphagia in multiple sclerosis patients using a Persian version of DYMUS questionnaire.

Mult Scler Relat Disord 2017 Oct 1;17:240-243. Epub 2017 Sep 1.

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

Background: Multiple sclerosis is a chronic neurological disease that may cause swallowing disorders. Dysphagia is a common problem, which patients with different levels of disability may encounter, but it is usually underestimated; therefore, effective assessments need to be performed before any serious complications. The aim of this study was to identify the frequency and characteristics of dysphagia in multiple sclerosis patients of Khuzestan MS society, using a Persian version of Dysphagia in Multiple Sclerosis (DYMUS) questionnaire.

Method: 105 consecutive MS patients (84 F and 21 M, mean age 33.8 ± 8.5 years, mean disease duration 3.5 ± 3.1 years, mean Expanded Disability Status Scale (EDSS) 1.8 ± 1.3) participated in the study and the DYMUS questionnaire was administered by a trained speech therapist.

Results: The results have shown that 55 MS patients (52.4%) had dysphagia and the dysphagia was significantly associated with the disease course of MS (p = 0.02). However, significant associations between DYMUS values and EDSS, disease duration, age, and gender were not observed. (Respectively, p = 0.4, p = 0.09, p = 0.1, p = 1.0). In the dysphagia group, based on dysphagia severity, 17.1% and 35.2% of patients had mild and alarming dysphagia, respectively. Although, the patients with alarming dysphagia had longer disease duration, higher EDSS score and more with SP, PP and PR disease course than the patients with mild dysphagia, these differences were not significant.

Conclusion: The oropharyngeal dysphagia in MS patients is very common even in early stages of the disease; therefore, it is important to assess these patients carefully and to initiate a treatment program if needed.
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http://dx.doi.org/10.1016/j.msard.2017.08.012DOI Listing
October 2017

Intratester and intertester reliability of the movement system impairment-based classification for patients with knee pain.

Man Ther 2016 Dec 5;26:117-124. Epub 2016 Aug 5.

Department of Physical Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.

Background: The methods to standardize the test items used for classification of patients with knee pain based on the movement system impairment (MSI) approach have been established. To our knowledge, no study has concentrated on establishing reliability for proposed classification for knee pain problems.

Objective: The aim of the study was to assess intra- and intertester reliability of the knee MSI classification in patients with knee pain.

Design: A cross-sectional methodological study.

Setting: Rasul Akram Hospital.

Participants: Ninety-six subjects with knee pain aged 18-65 years.

Methods: In order to examine intertester reliability, all three testers assessed the symptoms, signs and the MSI diagnosis of subjects with knee pain simultaneously. In order to assess intratester reliability, the procedure was exactly repeated after a one-week intersession period. Kappa values and percentages of agreement were calculated to analyze the reliability level.

Results: The kappa values for intra- and intertester reliability of the symptom items ranged from 0.83 to 1.00 and 0.00 to 0.83, respectively. For the sign items, the kappa values ranged from 0.18 to 1.00 and 0.00 to 0.82, respectively. Finally, the kappa values of intra- and intertester reliability for patients' classification judgments ranged from 0.66 to 0.71, and 0.48 to 0.58, respectively.

Conclusion: The results of the present study indicate that intertester reliability for the symptoms, signs and classification judgments of patients with knee pain based on the MSI approach seemed generally acceptable. However, for intratester reliability, lower levels of the system were observed, probably due to different pain levels or pain behavior between test and retest sessions.
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http://dx.doi.org/10.1016/j.math.2016.07.014DOI Listing
December 2016

Validation of the movement system impairment-based classification in patients with knee pain.

Man Ther 2016 Sep 2;25:19-26. Epub 2016 Jun 2.

Department of Physical Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.

Background: Categorizing patients with knee pain problems based on pathoanatomical sources has not proved to be the most effective method for directing physical therapy interventions. Movement system impairment (MSI) classification system may be an alternative in the assessment, diagnosis, and management of patients with knee pain. No previous study has been conducted to validate the proposed system in these patients.

Objective: To assess construct validity of the MSI classification system in patients with knee pain.

Design: A cross-sectional methodological study.

Setting: Rasul Akram Hospital.

Participants: One hundred eighty subjects with knee pain aged 18-65 years.

Methods: The MSI classification recognizes seven categories of knee pain problems based on the findings from the symptoms and signs assessment. Three physical therapists examined subjects with knee pain. A principal component analysis (PCA) was used to derive proposed categories. Eigenvalues and a scree plot were also used to determine the factor retention.

Results: Four factors related to three proposed categories were extracted from the PCA. Two factors were related to tibiofemoral rotation (TFR) category. The other two factors were related to proposed categories patellar lateral glide (PLG) and tibiofemoral hypomobility (TFHypo).

Conclusion: The results provided evidence for the construct validity of three (TFR, PLG, and TFHypo) of the seven categories proposed by MSI classification. In addition TFR was subcategorized into two groups which were named as tibial lateral rotation (TLR) and femoral adduction/medial rotation (FAdd/MR) in the present study.
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http://dx.doi.org/10.1016/j.math.2016.05.333DOI Listing
September 2016

Voice-related disability of Iranian patients with temporomandibular disorders.

J Voice 2014 Nov 28;28(6):841.e17-20. Epub 2014 Aug 28.

University of Tehran, Tehran, Iran.

Introduction: The relationship between handicaps because of voice disorders and temporomandibular disorders (TMDs) severity was examined.

Method: Fifty-two Persian women with temporomandibular disorder (TMD) were examined by two dentists in separate sessions and the assessment protocol of the Dentistry Clinic of Tehran University of Medical Sciences was filled by both dentists and finally they gave their opinion separately about the existence of TMD and categorized the severity of TMD as mild, moderate, and severe. To assess perceived disability resulting from voice disorders in TMD patients, the voice handicap index (VHI) questionnaire was used.

Results: The total score of VHI in 80.8% of patients with TMD was equal to or more than 14.5. A significant positive relationship was found between the severity of TMD and the total score of VHI (P = 0.000, r = 0.79).

Conclusions: It seems that a comprehensive voice assessment should be included in the evaluation of TMD, and considering different effects of voice disorders on patients' lives, a complete voice evaluation including voice-related disability is necessary to understand the nature of pathophysiology of TMD.
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http://dx.doi.org/10.1016/j.jvoice.2014.04.001DOI Listing
November 2014

Intrarater and interrater reliability of sagittal head posture: a novel technique performed by a physiotherapist and a speech and language pathologist.

J Voice 2014 Nov 18;28(6):842.e11-6. Epub 2014 Jun 18.

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

Introduction: Different professionals such as speech and language pathologists and voice scientists are involved in the evaluation of head and neck posture. Therefore, a reliable, time-efficient, and precise method of posture assessment is essential for use in clinical and research settings. Photogrammetry is one of the most commonly used methods to assess head and neck posture. The objectives of this study were to evaluate the intrarater reliability of the method with a large sample size and the interrater reliability by two different specialists (a physiotherapist and a speech and language pathologist).

Method: A total of three hundred four subjects (144 males and 160 females) aged between 18 and 28 years participated in the study. During the test session, a photograph was taken of the left-side profile of each subject in their ordinary and comfortable position. The head posture angle of each picture was calculated by two raters. The whole procedure was repeated in a retest session, 24 hours later. A total number of eight analyses were performed for each subject. The reliability was evaluated at several stages hierarchically and after confirming the reliability in each step, the next step was investigated. Paired t tests on the differences of scores obtained at all the aforementioned stages were used to ensure the absence of any systematic bias. To assess the reliability, intraclass correlation coefficients (ICCs) and the standard error of measurements (SEMs) were calculated.

Results: There was no significant difference between the mean values of the test and the retest angles at any stage of calculating the head posture angle in both pictures by both examiners (P > 0.05). The ICC and SEM values calculated for all stages were between 0.86-0.97 and 0.52-1.53, respectively.

Conclusion: Systematic bias has not occurred at any stage. The ICC and SEM values calculated have demonstrated that there were appropriate relative and absolute reliabilities in all stages. This method is suggested to be used simply in research and clinical areas by different specialists.
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http://dx.doi.org/10.1016/j.jvoice.2014.02.014DOI Listing
November 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

The effects of muscle fatigue on dynamic standing balance in people with and without patellofemoral pain syndrome.

Gait Posture 2013 Mar 1;37(3):336-9. Epub 2012 Sep 1.

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

The aim was to examine the effects of muscle fatigue of knee extensor and hip abductor muscles on dynamic standing balance of patients with patellofemoral pain syndrome (PFPS) compared to their healthy matched controls. Thirty participants (15 with PFPS, 15 controls) were recruited. Isolated muscle fatigue of two muscles was induced isokinetically in three separate sessions (one practice and two testing sessions) with a rest interval of at least 72h. In each testing session, fatigue protocol of only one muscle group was performed for the both legs with a rest time of 30min. After determining peak torque, participants were encouraged to perform continuous maximal concentric-eccentric contraction of the target muscle until the torque output dropped below 50% of peak value for 3 consecutive repetitions. Immediately after the completion of the fatigue protocol, balance testing of participants was undertaken during single leg standing using the Biodex stability system. Balance stability measures included the overall, anteroposterior and mediolateral stability indices (OSI, APSI and MLSI, respectively). Patients exhibited decreased balance stability in the sagittal plane (higher APSI) when compared to controls. Isolated muscle fatigue of the knee extensors and hip abductors reduced balance stability in both study groups. Fatigue of hip abductors was associated with greater balance instability (higher OSI and APSI) than fatigue of knee extensors.
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http://dx.doi.org/10.1016/j.gaitpost.2012.07.025DOI Listing
March 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

Functional balance in elderly with diabetic neuropathy.

Diabetes Res Clin Pract 2012 Apr 29;96(1):24-8. Epub 2011 Nov 29.

Department of Physical Therapy, University of Social Welfare and Rehabilitation, Daneshjoo Blvd., Velenjak, Tehran, Iran.

Distal Sensorimotor Polyneuropathy (DPN) is one of the most common long-term complications of diabetes mellitus. Patients with DPN are at a high risk for falling and its life-threatening consequences. The objective of present study was the evaluation of functional balance in patients with diabetic neuropathy and normal older adults. Thus, present case-control study was designed to test the ability of two fourteen DPN patients and healthy people to control functional balance using Berg Balance Scale (BBS). Furthermore, the correlation between DNE and BBS scores were calculated using the Spearman's correlation coefficient. Comparison of two groups showed a significant decline in the overall score of BBS in DPN patients versus to the healthy control group (P<0.001). The most challenging tasks for DNP patients were single leg stance, tandem standing and forward reaching (P<0.001), followed by standing unsupported with feet together, sit to stand, stand to sit, transfers, standing unsupported with closed eyes, and placing the alternative foot on step or stool while standing unsupported tasks (P<0.05). There was a significant (P<0.001) strong negative (r=-0.77) correlation between DNE and BBS scores. In conclusion, DPN results in a remarkable functional imbalance that may expose these patients to danger of falling during daily activities and becomes more severe as the severity of neuropathy aggravates.
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http://dx.doi.org/10.1016/j.diabres.2011.10.041DOI Listing
April 2012

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