The Effect of Additional Neuromuscular Training on Peri-Ankle Muscle Morphology and Function in Chronic Ankle Instability Subjects: A Randomized Controlled Trial.

BACKGROUND: Lateral ankle sprain is one of the most common musculoskeletal issues during sports and activities of daily living. This study investigated the effect of combined neuromuscular training and conventional training (including strengthening, range of motion, and balance exercises) on muscle morphology, dynamic balance, perceived ankle instability, and functional capacity in persons with chronic ankle instability (CAI). HYPOTHESIS: The combination of neuromuscular and conventional training programs might result in additional benefits on the morphology of muscle, dynamic balance, and functional capacity in subjects with CAI. STUDY DESIGN: A single-blind parallel-arm randomized controlled trial. LEVEL OF EVIDENCE: Level 2. METHODS: A total of 34 participants with CAI were divided randomly into experimental (EG) and control groups (CG). The EG received conventional and neuromuscular training, while the CG underwent conventional training. Cross-sectional areas of the peroneus longus and tibialis anterior muscles were measured using ultrasonography. Measurements included reaching direction distance, ankle instability, and the foot and ankle outcome score, all evaluated before and immediately after 12 intervention sessions and 4 weeks later in the follow-up phase. RESULTS: Repeated-measures analysis of variance (ANOVA) revealed significant improvement in the EG, particularly in the cross-sectional area of the tibialis anterior muscle on the injured side and the posteromedial reaching direction displacement of the Y balance test. Moreover, the EG's foot and ankle outcome scores increased significantly compared with the CG (P < 0.05). However, the group effect size ranged from minor to moderate (Hedges g, 0.40-0.73). CONCLUSION: Combining neuromuscular and conventional training programs yields greater benefits than conventional training alone regarding tibialis anterior muscle morphology, posteromedial dynamic balance, and functional capacity in persons with CAI. CLINICAL RELEVANCE: The combination of neuromuscular and conventional training programs could enhance muscle morphology, dynamic balance, perceived ankle instability, and functional capacity in persons with CAI.

The effect of trunk-stabilizing muscle training in women with stress urinary incontinence: A randomized controlled trial.

INTRODUCTION: There is little evidence regarding the effect of trunk-stabilizing muscle training on the improvement of stress urinary incontinence (SUI) symptoms. OBJECTIVE: To investigate the effect of trunk-stabilizing muscle training on transabdominal ultrasonography (TAUS) and clinical urological indices, and on the quality of life (QoL) in women with SUI. DESIGN: Randomized controlled trial. SETTING: A university hospital. PARTICIPANTS: Forty-six women with SUI, ages 20-55 years, were randomly assigned to an experimental (n = 23) and control group (n = 23). INTERVENTIONS: The experimental group performed trunk-stabilization exercises according to the Sapsford protocol, whereas the control group performed pelvic floor muscle (PFM) exercises for 8 weeks. MAIN OUTCOME MEASURES: The primary outcome measure was bladder base displacement (BBD), assessed by TAUS during PFM contraction (PFMC), Valsalva, and abdominal curl. The secondary outcome measures were PFM strength, the severity of urinary incontinence (UI), voiding diary, and QoL, assessed by the Modified Oxford Grading System, the severity index, frequency chart, and lower urinary tract symptoms-QoL questionnaire, respectively. All variables were assessed at baseline and after 8 weeks of intervention. RESULTS: The interaction of group and time was not significant for BBD during PFMC (p = .98), Valsalva (p = .28), abdominal curl (p = .34), and secondary variables (p > .05). The main effect of time was significant in both groups for BBD during PFMC, PFM strength, the severity of UI, voiding diary, and QoL (p < .001), with effect size (d) of 0.30, 0.80, 2.05, 1.07, and 1.03 in the control; and 0.49, 0.52, 1.75, 0.66, and 0.88 in the experimental group, respectively. The main effect of the group was not significant for BBD during PFMC (p = .68), Valsalva (p = .22), abdominal curl (p = .53), and secondary variables (p > .05). CONCLUSIONS: Trunk-stabilizing muscle training and PFM exercise are equally effective in the improvement of PFM function, UI symptoms, and QoL in women with SUI. Both methods can be used interchangeably by physical therapists.

Differences in Neurocognitive Functions Between Healthy Controls and Anterior Cruciate Ligament-Reconstructed Male Athletes Who Passed or Failed Return to Sport Criteria: A Preliminary Study.

BACKGROUND: Only 55% of anterior cruciate ligament-reconstructed (ACLR) athletes return to competitive sports. This brings into question the usefulness of current return to sport (RTS) criteria. High cognitive demand of sport environment clarifies the value of incorporating neurocognitive tests when making decisions regarding the time of RTS. This preliminary study aimed to compare the neurocognitive functions between healthy controls and ACLR male athletes who passed or failed RTS criteria. METHODS: A total of 45 male football players, including 15 ACLR who passed RTS criteria, 15 ACLR who did not pass, and 15 healthy controls participated in this cross-sectional study. The Cambridge Neuropsychological Test Automated Battery was used to measure a battery of neurocognitive tasks, including speed of response, sustained attention, working memory, cognitive flexibility, and response inhibition. RESULTS: The results revealed that compared with both the ACLR-passed and healthy groups, the ACLR-failed group showed greater values of 5-choice movement time (P = .02, P = .01, respectively) but lower values of stop signal reaction time (P = .03, P = .001, respectively) and proportion of successful stops variables (P = .02). In addition, compared with the healthy group, both the ACLR-failed and ACLR-passed groups indicated greater values in between errors (P < .001, P = .008, respectively) and reaction latency variables (P = .002, P = .01, respectively) but lower values of A' (P < .001, P = .007, respectively), probability of hit (P < .001, P = .03, respectively), and percent correct trials variables (P = .006, P = .02, respectively). CONCLUSIONS: Our findings indicated deficits in neurocognitive functions in ACLR male athletes. In addition, poor performance in sustained attention, working memory, and cognitive flexibility measures observed in the ACLR-passed group highlighted the necessity for using a multimodal approach via implementation of neurocognitive measures in conjunction with the functional and muscular assessments when making RTS decisions.

The Effect of McGill Core Stability Training on Movement Patterns, Shooting Accuracy, and Throwing Performance in Male Basketball Players: A Randomized Controlled Trial.

CONTEXT: Core stability training has been recommended as a vital element in improving movement's pattern and athletic performance. The main objective of this study was to investigate the effect of 12-week McGill core stability training on movement patterns, shooting accuracy, and throwing performance. DESIGN: Randomized controlled clinical trial. SETTING: University research laboratory. METHODS: Forty male basketball players were randomly assigned to experimental and control groups. The experimental group completed 12-week McGill core stability training, while the control group completed routine exercise training. Patterns of functional movements was measured through functional movement screen (FMS), shooting accuracy measured by static 3-point shooting (S3P) and dynamic 60-second 3-point shooting test, and throwing performance measured by Functional Throwing Performance Index. RESULTS: Comparison revealed that regardless of received training, after 12 weeks both groups showed significant improvement in all outcome measures. However, experimental group had significantly higher post test scores in FMS (P = .02), S3P (P = .007), and dynamic 60-second 3-point shooting test (P = .01). For Functional Throwing Performance Index, there was no group differences (P = .96). The results of follow-up assessments showed for all measurements including FMS (P = .03), S3P (P = .004), dynamic 60-second 3-point shooting test (P < .001), and Functional Throwing Performance Index (P = .005); experimental group had higher scores than the control group. CONCLUSIONS: According to the results, implementing McGill core stability training in basketball routine training would be advisable since significant improvement can be obtained in the measured parameters.

The Western Ontario and McMaster Universities Osteoarthritis, Lequesne Algofunctional index, Arthritis Impact Measurement Scale-short form, and Visual Analogue Scale in patients with knee osteoarthritis: responsiveness and minimal clinically important differences.

PURPOSE: The goal of this study was to see whether the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC), Lequesne Algofunctional index and the Arthritis Impact Measurement Scale-short form (AIMS2-SF) could changes after physiotherapy interventions (i.e., responsiveness) and to determine Minimal Clinically Important Difference (MCID) in the performance of the people with knee osteoarthritis. MATERIALS AND METHODS: A convenient sample of 116 people with knee osteoarthritis completed the tools at baseline and then again after 10 sessions physiotherapy intervention. Two techniques were used to determine responsiveness: The receiver operating characteristics (ROC) method and the correlation analysis. RESULT: All of the tools showed the AUC of greater than 0.70 (AUC ranges = 0.72 - 0.83). For the WOMAC, Lequesne Algofunctional index, AIMS2-SF and VAS-pain, optimal cutoff points were 12.5, 2.75, 4.5 and 2.5 points, respectively. The gamma correlation between WOMAC, Lequesne Algofunctional index, AIMS2-SF, VAS-pain, and Global Rating Change (GRC) scores was 0.55, 0.52, 0.40, and 0.46, respectively. CONCLUSION: In people with knee osteoarthritis, the WOMAC has the maximum responsiveness to clinical changes. The MCID values identify in this study will aid in determining whether or not an individual with knee osteoarthritis has undergone a true improvement since receiving physiotherapy. IMPLICATIONS FOR REHABILITATIONThe results of this study provide valuable information regarding to the ability of outcome measures to detect treatment effects in patients with knee osteoarthritis.The WOMAC questionnaire is a responsive tool to measure the changes in functional activity due to physiotherapy intervention in patients with knee osteoarthritis.A patient with knee osteoarthritis had to change at least 12.5 scores on the WOMAC to be judged as having clinically changed.

Effects of back extensor and hip abductor fatigue on dynamic postural stability in patients with nonspecific chronic low back pain: A case-control study.

INTRODUCTION: Patients with nonspecific chronic low back pain (NSCLBP) complain of pain and fatigue during functional activities. Poor back muscle endurance has been associated with recurrent pain and long-term disability. However, the relationship between proximal muscle fatigue and postural stability is not well understood. PURPOSE: To investigate the effects of lumbar extensor and hip abductor fatigue on postural stability in NSCLBPs. METHODS: To induce isolated fatigue, participants (24 LBPs, 24 controls) were asked to perform multiple back extension and hip abduction in the separate sessions until the muscle force reached 60% of pre-fatigued force. The overall (OSI), anteroposterior (APSI), and mediolateral (MLSI) stability indices were measured during single-leg stance using the Biodex dynamic platform. RESULTS: The results revealed higher postural instability (APSI and OSI) following fatiguing lumbar extensor and hip abductor muscles (greater effect size for APSI than OSI) in LBPs than controls. Furthermore, significant and inverse relationships were found between the level of physical activity, pain, and post-fatigue postural instability (OSI) in NSCLBPs. CONCLUSION: Fatigue of proximal muscles could differentiate postural stability primarily in the sagittal plane between NSCLBPs and controls. Therefore, reducing the fatigability of these muscles by endurance training in addition to balance training may improve physical activity.

Reliability of musculoskeletal ultrasonography for peri-ankle muscles in subjects with unilateral chronic ankle instability.

BACKGROUND: Ankle sprain is a common problem among active people and athletes. It causes reduces their activity of daily living and quality of life. Because of the impaired muscle strength and neuromuscular and postural control, it seems that the morphological criteria of peri-ankle muscles are changed. OBJECTIVE: This study aimed to develop a reliable method for measuring tibialis anterior (TA) and peroneus longus (PL) muscles in the injured and intact side of lower limbs in people with unilateral chronic ankle instability (CAI). STUDY DESIGN: Cross-sectional study. METHOD: This study was intra-tester reliability by ultrasound imaging to measure ultrasonography characteristics contains thickness, width, fiber length, pennation angle, and cross-sectional area (CSA) of TA, and PL in both limbs of 25 subjects at three separate times. Intra-class correlation coefficients (ICC), limits of agreement (LOA), standard error of measurement (SEM), and minimal detectable change (MDC) were calculated to analyzed relative and absolute intra-tester reliability, respectively. RESULTS: The present study showed good to excellent relative reliability for both injured and intact sides (ICC 0.88-0.98), less proportional measurement error (ß coefficient of LOA≈ 0), and suitable absolute reliability. CONCLUSION: Musculoskeletal ultrasonography is a reliable method for the measurement of peri-ankle muscle morphology such as thickness, width, CSA, fiber length, and pennation angle.

Correlation Between the 6-Min Walk Test and Exercise Tolerance Test in Cardiac Rehabilitation After Coronary Artery Bypass Grafting: A Cross-sectional Study.

INTRODUCTION: Exercise capacity and quality of life are the main outcomes in cardiac rehabilitation (CR). Exercise capacity is one of the important prognostic and diagnostic measures acquired by the exercise tolerance test (ETT). The 6-min walk test (6MWT), as a functional walking test, is another tool for assessing exercise capacity. METHODS: Eighty postoperative coronary artery bypass grafting (CABG) participants admitted to three CR units were recruited for this cross-sectional and multicenter study, based on convenient non-probability sampling. All participants performed an ETT and two repeated 6MWTs. Maximum heart rate (HR), maximum blood pressure (BP), maximal oxygen uptake (VO2max), and peak metabolic equivalents of tasks (MET) during the tests and also the 6-min walk distance (6MWD) were the outcome measures. RESULTS: The mean age of all participants was 62.13 (7.12) years and 80% were male. Pearson correlation showed that maximum HR (r(78) = 0.67, P < 0.001) and maximum systolic BP (r(78) = 0.57, P < 0.001) during the 6MWT correlated moderately with those achieved during ETT. Maximum HR in the 6MWT corresponded to 86% of that achieved during ETT. The 6MWD showed a strong positive correlation with peak MET estimated during ETT as a measure of exercise capacity (r = 0.77, P < 0.001). CONCLUSIONS: The results from this study suggest that the 6MWT is a valid tool for assessing functional capacity for prescribing exercise in a group of postoperative CABG participants admitted to CR units. This finding is helpful for healthcare professionals and for patients, as the test is easy to administer and also well tolerated by patients. TRIAL REGISTRATION NUMBER: PHT-9923.

Transabdominal Ultrasound Imaging of Pelvic Floor Muscle Activity in Women With and Without Stress Urinary Incontinence: A Case-Control Study.

OBJECTIVE: Transabdominal ultrasound (TAU) is an easy and noninvasive way to evaluate and retrain pelvic floor muscle (PFM) function. The purpose of this study was to compare PFM activity in women with and without urinary incontinence (UI) by measuring bladder base displacement (as a marker for PFM activity) using TAU during PFM contraction, Valsalva's maneuver, and abdominal curl. METHODS: Sixty-three women, aged 20-55 years, volunteered to participate in this cross-sectional study: 21 were continent and 42 had UI (21 stress urinary incontinence [SUI] and 21 mixed urinary incontinence [MUI]). Mean bladder base displacement in millimeters was measured to evaluate differences between the three groups (continent, SUI, and MUI) and also between the continent and UI groups during the performance of each maneuver. RESULTS: No significant differences were seen between the three groups in bladder base elevation during PFM contraction (P > 0.05). Descent of the bladder base during Valsalva's maneuver and abdominal curl was significantly greater in women with SUI and MUI than in women in the continent group (P < 0.05). Comparison of the continent and UI groups showed no significant differences in elevation of the bladder base during PFM contraction, while descent of the bladder base was significantly greater in women with UI than in women in the continent group during Valsalva's maneuver and abdominal curl (P < 0.05). CONCLUSION: TAU indicated that bladder base descent was greater in women with SUI and MUI than those in the continent group during the performance of maneuvers that increased intra-abdominal pressure. This effect may be due to decreased PFM performance in women with urinary incontinence.

Inter-joint coordination during obstacle crossing in people with diabetic neuropathy.

Sensori-motor deficit due to diabetic peripheral neuropathy (DPN) alters the quality of obstacle-crossing which may increase the risk of falling. The aim of this study was to compare inter-joint coordination (IJC) during obstacle-crossing between people with DPN and healthy controls. Fifteen DPN and 15 healthy people crossed over obstacles with heights of 10% and 20% of the subject's leg length. The mean absolute relative phase (MARP) and deviation phase (DP) of both leading and trailing limbs were used to calculate the phase dynamic and variability of IJC. Furthermore, correlation between Berg Balance Scale (BBS), Fall Efficacy Scale (FES-I), Timed Up and Go (TUG) and MARP, DP were assessed in DPN group. There was no significant interaction between group and obstacle height on measured variables. However, Group had significant main effect on DP of hip-knee in leading limb (p < 0.05). Additionally, the main effects of the obstacle's height were significant on MARP of hip-knee of trailing limb (p < 0.01) and knee-ankle in leading limb (p < 0.05). FES-I was significantly correlated to hip-knee and knee-ankle MARPs of leading limb for crossing over 20% and knee-ankle MARP for crossing over 10% height obstacle (r = 0.68, 0.69, 0.59, respectively, p < 0.05). This score was also significantly correlated with hip-knee DP of both trailing and leading limbs when crossing 10% obstacle (r = 0.59, 0.57, respectively, p < 0.05). In conclusion, IJC during obstacle-crossing was less variable and more out-of-phase, as a result of DPN and obstacle height, respectively. Moreover, when crossing over lower obstacles, fear of falling is related to IJC dynamics and variability of more proximal segment, especially in the leading limb.

Validation and responsiveness of the Persian version of HeartQoL questionnaire in cardiac rehabilitation after coronary artery bypass grafting: An observational study.

BACKGROUND: Decision making and the quality of care provided for chronic diseases have been shown to improve through patient participation. The HeartQoL questionnaire is a core health-related quality of life (HRQOL) tool specifically designed for individuals with ischemic heart disease (IHD) who have undergone interventions such as cardiac rehabilitation (CR). METHODS: In this observational and multicenter study, 150 patients were recruited. The participants completed the HeartQoL, MacNew Heart Disease Questionnaire, and Short Form Health Survey (SF-36) on entering CR for validity assessment. The HeartQoL along with a Global Rating of Change (GRoC) scale (for responsiveness measurement) were completed by 100 participants 3 months later. RESULTS: The mean age of all participants in validity assessment was 61.87 ± 8.13 years. Cronbach's alphas of the total scales ranged from 0.70 to 0.81 and of the subscales from 0.70 to 0.82. The Pearson correlation coefficient was used to determine construct validity; similar constructs were confirmed with correlation coefficients ranging from 0.50 to 0.69 and dissimilar constructs with correlation coefficients ranging from 0.28 to 0.29 (P < 0.010). The assessment of the responsiveness of the questionnaire indicated that the area under curve (AUC) was greater than 0.70 (range: 0.74 to 0.91) and the optimal cut-off point was 0.65. CONCLUSION: The Persian version of the HeartQoL questionnaire demonstrated satisfactory psychometric properties in the sample of participants admitted to CR after coronary artery bypass grafting (CABG). The present study results showed that the HRQOL can be used by clinicians and researchers in conjunction with other outcome measures to gain additional information about symptoms relevant to HRQOL in patients referred to CR and to evaluate change over time.

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.

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

Comparing the effects of external focus of attention and continuous cognitive task on postural control in anterior cruciate ligament reconstructed athletes.

External focus (EF) of attention and continuous cognitive task (CCT) reduced postural sway in young and adult people owing to the automatic process of postural control, but their effects on postural control in athletes with musculoskeletal injury like anterior cruciate ligament (ACL) reconstruction are unclear. The present study aimed to reveal the effects of EF of attention and CCT on postural control in ACL reconstructed (ACL-R) athletes by comparing the pattern of the condition-group interaction between ACL-R and healthy athletes. The participants included healthy athletes (n = 20) and ACL-R athletes (n = 20). Postural control was examined during an operated leg stance on a wobble board positioned on a force plate. Three conditions were performed: single postural task (control condition), postural task with EF of attention (focusing on a planar leveling app in a smartphone placed on the wobble board) and postural task concurrent with CCT (three-digit sequence task). Measurement parameters, including sway area, amplitude, velocity, and mean power frequency (MPF), were the traditional center of pressure (COP) variables. A significant difference was found between ACL-R athletes and healthy subjects for the AP amplitude in the control condition as well as the ML amplitude in the CCT condition. Furthermore, in the ACL-R group, cognitive demand significantly decreased postural sway, while postural sway was not different between the conditions for the healthy group. Results also indicated that CCT significantly decreased sway velocity and increased mean power frequency in both groups, while EF of attention did not change any COP measures. Concurrent CCT decreases postural sway in ACL-R athletes, while it does not have significant effects on healthy subjects. EF of attention did not affect postural control in both study groups.

Dynamic postural control during step down task in patients with patellofemoral pain syndrome.

[Purpose] This study aimed to examine the differences in dynamic postural control during forward step down (FSD) task in patients with patellofemoral pain syndrome (PFPS). [Participants and Methods] Sixty-eight participants (34 males and 34 females) were divided into the following 2 groups: 34 PFPS patients (17 males and 17 females) and 34 healthy controls (17 males and 17 females). Each participant performed FSD task from a height of 20 cm. A force platform was used to extract the center of pressure parameters during FSD task for calculation of time to stabilization (TTS) in the anterior-posterior (A/P) and medial-lateral (M/L) direction. [Results] PFPS group took longer time to stabilize than the healthy control group in A/P and M/L directions. A main effect for direction was found, and this indicated that the A/P TTS of 8.43 ± 0.79s was longer than the M/L TTS of 5.56 ± 1.95s in healthy participants and A/P TTS of 9.09 ± 0.82s was longer than the M/L TTS of 7.15 ± 2.11s in PFPS. [Conclusion] These findings suggest that dynamic postural control can be affected in PFPS patients.

Responsiveness of Static and Dynamic Postural Balance Measures in Patients with Anterior Cruciate Ligament Reconstruction Following Physiotherapy Intervention.

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

Posture-cognition interaction during quiet standing in patients with knee osteoarthritis.

The aim of this study was to determine the effects of cognitive task (silent backward counting) on postural control in patients with knee osteoarthritis (OA) (n = 25) as compared with asymptomatic controls (n = 25). Static postural control during quiet standing was assessed under different conditions including: (1) rigid surface-open eyes; (2) rigid surface-closed eyes; (3) foam surface-open eyes; and (4) foam surface-closed eyes. Dependent variables were center of pressure (COP) parameters and cognitive score. The results of this study showed that for most COP parameters, the patients with knee OA had greater postural sway than asymptomatic control subjects. Moreover, while cognitive loading affects postural sway in dual-task compared to single-task conditions, the pattern of change was not different between the two groups. Cognitive loading caused decreased postural sway in both groups. Future studies should select patients with more disability, choose more attention demanding cognitive tasks, and expose the subjects to dynamic balance situations to further explore the effect of cognitive loading on postural performance in this specific patient population.

Reliability, validity, and responsiveness of the Persian version of Shoulder Activity Scale in a group of patients with shoulder disorders.

PURPOSE: The aim of this methodological study was to cross-culturally translate the Shoulder Activity Scale (SAS) into the Persian and determine its clinimetric properties including reliability, validity, and responsiveness in patients with shoulder disorders. METHOD: Persian version of the SAS was obtained after standard forward-backward translation. Three questionnaires were completed by the respondents: SAS, shoulder pain and disability index (SPADI), and Short-Form 36 Health Survey (SF-36). The patients completed the SAS, 1 week after the first visit to evaluate the test-retest reliability. Construct validity was evaluated by examining the associations between the scores on the SAS and the scores obtained from the SPADI, SF-36, and age of the patients. To assess responsiveness, data were collected in the first visit and then again after 4 weeks physiotherapy intervention. Test-retest reliability and internal consistency were assessed using Intra-class Correlation Coefficient (ICC) and Cronbach's alpha, respectively. To evaluate construct validity, Spearman's rank correlation was used. The ability of the SAS to detect changes was evaluated by the receiver-operating characteristics method. RESULTS: No problem or language difficulties were reported during translation process. Test-retest reliability of the SAS was excellent with an ICC of 0.98. Also, the marginal Cronbach's alpha level of 0.64 was obtained. The correlation between the SAS and the SPADI was low, proving divergent validity, whereas the correlations between the SAS and the SF-36/age were moderate proving convergent validity. A marginally acceptable responsiveness was achieved for the Persian SAS. CONCLUSIONS: The study provides some evidences to support the test-retest reliability, internal consistency, construct validity, and responsiveness of the Persian version of the SAS in patients with shoulder disorders. Therefore, it seems that this instrument is a useful measure of shoulder activity level in research setting and clinical practice. IMPLICATIONS FOR REHABILITATION: The shoulder activity scale (SAS) is a reliable, valid, and responsive measure of shoulder activity level in Persian-speaking patients with different shoulder disorders. The results on clinimetric properties of the Persian SAS are comparable with its original, English version. Persian version of the SAS can be used in "clinical" and "research" settings of patients with shoulder disorders.

Attentional demands of postural control during single leg stance in patients with anterior cruciate ligament reconstruction.

The aim of this study was to investigate the amount of attention demands of postural control in patients with anterior cruciate ligament-reconstruction (ACL-R), by comparing the pattern of posture-cognition interaction between two groups of ACL-R patients (n=25) and healthy matched controls (n=25). All participants were examined during single-leg stance on a balance board under both single- and dual-task conditions in 4 dynamic balance tests. These tests were standing on the injured and uninjured legs with straight or flexed knees. The corresponding dominant and non-dominant legs of healthy group were considered as controls. Contact frequency and contact time were acquired as a measure of postural performance. Cognitive performance was assessed by counting the number of errors in a silent backward digit span task. The results of analysis of variance showed a significant higher contact frequency and longer contact time in patients with ACL-R compared to healthy matched controls (p<0.02). Moreover, the ACL-R patients showed a significantly higher contact frequency and longer contact time during dual-task compared to single-task conditions (p<0.01). This pattern of posture-cognition interference was not observed in the healthy control group. In conclusion, patients who had undergone ACL-R surgery demonstrated poorer balance stability during single-leg stance than healthy controls. Also, simultaneous execution of the cognitive task during standing caused a significant deterioration in postural stability which indicates decreased automaticity (increased attention demanding) of postural control in patients with ACL-R compared to healthy controls.

Massage therapy and exercise therapy in patients with multiple sclerosis: a randomized controlled pilot study.

OBJECTIVE: The primary aim was to investigate the comparative effects of massage therapy and exercise therapy on patients with multiple sclerosis. The secondary aim was to investigate whether combination of both massage and exercise has an additive effect. DESIGN: Randomized controlled pilot trial with repeated measurements and blinded assessments. SETTING: Local Multiple Sclerosis Society. SUBJECTS: A total of 48 patients with multiple sclerosis were randomly assigned to four equal subgroups labelled as massage therapy, exercise therapy, combined massage-exercise therapy and control group. INTERVENTIONS: The treatment group received 15 sessions of supervised intervention for five weeks. The massage therapy group received a standard Swedish massage. The exercise therapy group was given a combined set of strength, stretch, endurance and balance exercises. Patients in the massage-exercise therapy received a combined set of massage and exercise treatments. Patients in the control group were asked to continue their standard medical care. MAIN MEASURES: Pain, fatigue, spasticity, balance, gait and quality of life were assessed before and after intervention. RESULTS: Massage therapy resulted in significantly larger improvement in pain reduction (mean change 2.75 points, P = 0.001), dynamic balance (mean change, 3.69 seconds, P = 0.009) and walking speed (mean change, 7.84 seconds, P = 0.007) than exercise therapy. Patients involved in the combined massage-exercise therapy showed significantly larger improvement in pain reduction than those in the exercise therapy (mean change, 1.67 points, P = 0.001). CONCLUSIONS: Massage therapy could be more effective than exercise therapy. Moreover, the combination of massage and exercise therapy may be a little more effective than exercise therapy alone.