Sensitivity and specificity of normalized truncated navicular height in assessment of static foot posture in children aged 6-12 years.

BACKGROUND: Normalized truncated navicular height (NTNH) is a non-invasive, easy to perform, and simple clinical measure of static foot posture. However, its sensitivity and specificity in evaluation of the static foot posture in children have not been investigated yet. OBJECTIVE: To investigate the intra-rater reliability, sensitivity, and specificity of NTNH in evaluation of the static foot posture in children using radiographic measure as a gold standard measure. METHODS: A cross-sectional study of a random sample of 300 school children aged 6-12 years old. Intra-rater reliability, minimal detectable change, sensitivity, and specificity of NTNH were investigated. NTNH as a clinical measure of static foot posture was calculated and compared to the radiographic measure and displayed on the receiver operating characteristic (ROC) curve. RESULTS: NTNH demonstrated an intra-rater reliability of ICC = 0 . 98 . The sensitivity and specificity of NTNH were 88.1% and 99.5%, respectively. The optimal cutoff point for the diagnosis of flat foot using NTNH in children aged 6-12 years is NTNH ≤ 0 . 19 . CONCLUSION: NTNH is a sensitive and specific measure of static foot posture in the children aged 6-12 years. It is recommended to be used as a screening measure of static foot posture in children as it is easy, simple to perform, and a non-invasive clinical measure.

Can the stroke impact scale 3.0 detect cognitive impairments in patients with a recent stroke?

[Purpose] The aim of this study was to identify cognitive impairments in patients with a recent stroke using Stroke Impact Scale 3.0 (SIS). [Participants and Methods] A retrospective cohort study was conducted to evaluate 50 medical records in patients with a recent stroke who have completed a stroke rehabilitation programme. All data were evaluated at St. Finbarr's Hospital in Cork, Ireland. [Results] A total of 41 records met the inclusion criteria, of which 53.7% were male. Regarding the risk factors, most patients complained of hypertension (85.4%), with most being diagnosed with embolic stroke (56.1%). The SIS identified numerous issues in stroke patients, such as persistent problems with memory (36.6%), concentration (29.3%), and solving everyday problems (43.9%). In addition, some patients' responses were negative regarding their emotion such as feeling sad (51.2%), not enjoying things as much as ever (39%), feeling life is not worth living (85.4%) and not smiling or laughing at least once a day (80.5%). [Conclusion] The inclusion of the SIS in the stroke review clinic identified cognitive deficits that may not have otherwise been detected. By using SIS in a systematic and standardised way, deficits can be identified, and appropriate rehabilitation can be provided.

Does improvement towards a normal cervical sagittal configuration aid in the management of cervical myofascial pain syndrome: a 1- year randomized controlled trial.

BACKGROUND: There is a growing interest concerning the understanding of and rehabilitation of the sagittal configuration of the cervical spine as a clinical outcome. However, the literature on the topic specific to conservative treatment outcomes of patients with chronic myofascial cervical pain syndrome (CMCPS) has not adequately addressed the relationship between cervical sagittal alignment and improved pain, disability and range of motion. METHODS: A randomized controlled study with a 1-year follow-up. Here, 120 (76 males) patients with chronic CMCPS and defined cervical sagittal posture abnormalities were randomly assigned to the control or an intervention group. Both groups received the Integrated neuromuscular inhibition technique (INIT); additionally, the intervention group received the denneroll cervical traction device. Alignment outcomes included two measures of sagittal posture: cervical angle (CV), and shoulder angle (SH). Patient relevant outcome measures included: neck pain intensity (NRS), neck disability (NDI), pressure pain thresholds (PPT), cervical range of motion using the CROM. Measures were assessed at three intervals: baseline, 10 weeks, and 1 year after the 10 week follow up. RESULTS: After 10 weeks of treatment, between group statistical analysis, showed equal improvements for both the intervention and control groups in NRS (p = 0.36) and NDI (p = 0.09). However, at 10 weeks, there were significant differences between groups favoring the intervention group for PPT (p<0.001) and all measures of CROM (p<0.001). Additionally, at 10 weeks the sagittal alignment variables showed significant differences favoring the intervention group for CV p<0.001 and SH (p<0.001) indicating improved CSA. Importantly, at the 1-year follow-up, between group analysis identified a regression back to baseline values for the control group for the non-significant group differences (NRS and NDI) at the 10-week mark. Thus, all variables were significantly different between groups favoring the intervention group at 1-year follow up: NRS (p<0.001), NDI (p<0.001), PPT p<0.001), CROM (p<0.001), CV (p<0.001), SH (p<0.001). CONCLUSION: The addition of the denneroll cervical orthotic to a multimodal program positively affected CMCPS outcomes at long term follow up. We speculate the improved sagittal cervical posture alignment outcomes contributed to our findings. TRIAL REGISTRATION: Pan African Clinical Trial Registry Clinical Trial Registry: PACTR201801002968301 , registered 11 January 2018 (retrospectively registered).

Kinematic characteristics of reaching in children with hemiplegic cerebral palsy: A comparative study.

BACKGROUND: Practitioners need more sensitive measures to quantify reaching movement for judgement of the treatment effects and reflecting the degrees of motor impairment in upper extremities. OBJECTIVE: The purposes of this study were to differentiate between spastic and normal reaching using three-dimensional (3D) motion analysis and to quantify the interference of spasticity on reaching movement in children with congenital hemiplegic cerebral palsy. METHODS: Fifteen children with hemiplegic CP as a study group and 15 normal typically-developing (TD) children as a control group were studied. Participants were asked to reach forward, at a self-selected pace, toward one target at a normalized distance. A motion analysis system was used to record the trajectory of reaching performance. Kinematic parameters were computed and analysed. RESULTS: There were significant differences between the normal and spastic reaching (p < 0.001). Hemiplegic CP demonstrated slower and less smooth (higher normalized jerk score and more movement units) movement than the TD group, this reflects feedback guidance to correct spatial inaccuracy of reaching in hemiplegic CP. CONCLUSION: Kinematic analysis quantifies reaching characteristics and provides objective information about the motor strategies associated with goal-oriented tasks.

Connexin 26 gene mutations in non-syndromic hearing loss among Kuwaiti patients.

OBJECTIVE: To study connexin 26 (Cx26) gene mutations among autosomal recessive non-syndromal hearing loss in Kuwaiti patients and evaluate their effect on phenotypes. SUBJECTS AND METHODS: This cross sectional study included 100 patients aged between 6 months and 18 years, who were referred to the Sheikh Salem Al-Ali Centre for audiology and speech evaluation of autosomal recessive non-syndromic sensorineural hearing loss confirmed by clinico-genetic evaluation and a battery of diagnostic tests. Gene profiling and sequencing were performed to detect the presence and nature of Cx26 mutation. RESULTS: Of the 100 patients, mutation of Cx26 gene was detected in 15 patients (15%) of which 9 (60%) cases were heterozygous and 6 cases (40%) were homozygous. Eighty per cent of the 15 Cx26 positive cases resulted from the 35delG mutation. Among the heterozygous cases, 6 (66.6%) were positive for 35delG. All 6 homozygous patients were positive for the 35delG mutation. A significant correlation was found between genetic findings (p = 0.013) and family history (p = 0.029), as well as the onset (p = 0.015), course (p = 0.033), degree and configuration of hearing loss (p = 0.001). CONCLUSION: Among the selected Kuwaiti population sample, the Cx26 gene mutation was responsible for 15% of autosomal recessive non-syndromic sensorineural hearing loss. We recommend that screening for Cx26 gene mutation be considered in the screening strategy of patients with non-syndromic childhood hearing loss for counselling and management purposes. .

Enhancing Footwear Safety for Fall Prevention in Older Adults: A Comprehensive Review of Design Features.

BACKGROUND: Falls are a global concern affecting people of all ages; however, older adults are particularly vulnerable to age-related factors and foot-related issues. Footwear is critical for preventing falls, as it provides stability and protection against slips, trips, and falls (STFs). However, a significant gap exists in the systematic exploration of the safety aspects of footwear design for fall prevention in older adults. METHODS: This comprehensive review applied a meticulous search strategy encompassing prominent databases, including Google Scholar, ScienceDirect, SCOPUS, MEDLINE, ResearchGate, and PubMed. This review synthesized and analyzed existing research to bridge knowledge gaps and provide insights into optimal footwear choices for older adults in terms of design features such as fit, fixation, heel height, collar height, slip resistance, and sole/insole hardness. RESULTS: The results underscore the importance of specific design features for preventing falls among older adults. A proper fit, secure fixation, appropriate heel and collar heights, slip resistance, and sole/insole hardness significantly contributed to fall prevention. These findings offer valuable guidance for optimizing footwear designs to enhance comfort, stability, and safety in the daily lives of older individuals. CONCLUSION: This comprehensive review fills a critical knowledge gap regarding the safety of footwear designs for fall prevention in older adults. The identified design features play a vital role in reducing the risk of falls and offer practical recommendations for the development of safer footwear. Ultimately, this study contributes to the existing knowledge base and supports efforts to prevent STFs in older adults through improved footwear design.

Cardiopulmonary Response in Post-COVID-19 Individuals: A Cross-Sectional Study Comparing the Londrina Activities of Daily Living Protocol, 6-Minute Walk Test, and Glittre Activities of Daily Living Test.

This study addresses the imperative need for reliable assessment protocols in guiding rehabilitation interventions for individuals post-COVID-19, considering the enduring physiological effects of the virus. A cohort of 40 post-COVID-19 individuals underwent assessments using the Londrina ADL protocol, Glittre ADL test, and the 6-minute walk test (6MWT). Physiological parameters were recorded during and after each test, including heart rate, respiratory rate, and oxygen saturation. The post hoc comparisons between the pre-test and post-test cardiopulmonary response of the three tests showed significant differences, except diastolic blood pressure (6MWT vs. Londrina ADL protocol), heart rate (6MWT vs. Londrina ADL protocol), respiratory rate (6MWT vs. Londrina ADL protocol), blood oxygen level (SpO2) (6MWT vs. Londrina ADL protocol), dyspnea (Londrina ADL protocol vs. Glittre ADL test), and fatigue (Londrina ADL protocol vs. Glittre ADL test). The Londrina ADL protocol demonstrated cardio-pulmonary responses comparable to the Glittre ADL test, as well as the 6MWT, emphasizing its effectiveness in evaluating walking-related outcomes. The study concludes that the Londrina ADL protocol is a robust and practical tool for the routine clinical testing of daily living activities in post-COVID-19 individuals. While the 6MWT remains valuable for assessing walking-related outcomes, a combined approach employing the Londrina ADL protocol and 6MWT offers a comprehensive strategy for evaluating multifaceted functional capacities in this population.

Physiotherapists' practice patterns for the diagnosis and management of patients with chronic contracted frozen shoulder in the United Arab Emirates.

BACKGROUND: Adhesive capsulitis or contracted shoulder, known as frozen shoulder, is a persistent painful condition that may last for more than three months. It is a common disease-causing morbidity that causes pain and loss of shoulder range of motion. Physical therapy is advocated for the restoration of a pain-free state and normal use of the upper extremity, along with other interventions. PURPOSE: This study aimed to explore the level of current clinical practice for managing chronic contracted frozen shoulder (CCFS) among physiotherapy professionals in the United Arab Emirates (UAE) compared to well-established evidence-based practices, and to identify the most common therapy practiced in UAE to manage CCFS. METHOD: This study was based on a cross-sectional quantitative analysis using an adapted questionnaire. The main themes of questions were the presence of a special interest in CCFS, management options, symptoms, diagnosis, referral, and best physiotherapy intervention recommendations. The results were analyzed using simple descriptive analyses, such as frequency, mean, and percentage of total responses; additionally, thematic and content analyses were performed for open-ended questions. RESULTS: Overall, 101 physiotherapy professionals participated in the survey: 62% female and 38% male; 59% were bachelors- and 36% masters-degree holders, respectively. In the closed ended question regarding the interest in CCFS, male physiotherapists (PTs) were more interested than females (82% vs. 68%). For the most common indication of CCFS, 76% of the participants selected "Limitation of movement" as the main indication. However, only 42% confirmed the presence of clinical protocols in their employment setting. In their opinion, the most effective therapies were patient education, superficial heat or cold, manual joint mobilization, and sustained stretching exercises. CONCLUSION: A well-established professional competence exists among physiotherapists in the UAE to manage and treat patients with CCFS. The findings showed sufficient standard, theoretical, and practical knowledge among the study groups.

Cardiorespiratory Response to Six-Minute Step Test in Post COVID-19 Patients-A Cross Sectional Study.

BACKGROUND AND PURPOSE: New coronavirus disease 2019 (COVID-19) can cause persistent symptoms and physical weakness that can lead to a limitation in activities of daily living (ADL). There is a lack of evidence about the performance in the six-minute step test (6MST) of post-COVID-19 patients and healthy subjects. The aim of this study is to investigate the cardiorespiratory response induced by the 6MST in post-COVID-19 patients and compare it with the response of the six-minute walk test (6MWT). METHODS: This cross-sectional study was conducted on 34 post-COVID-19 patients and 33 healthy subjects. The assessment was performed at one month from a non-severe SARS-CoV-2 infection. Both groups were assessed by using the 6MST, 6MWT, and the pulmonary function test (PFT). Post COVID functional status (PCFS) scale was used for the post-COVID-19 group to assess functional status. Physiological responses; heart rate (HR), respiratory rate (RR), oxygen saturation (SpO2), blood pressure (BP), and Borg scale for fatigue and dyspnea were recorded before and after the 6MST and 6MWT. RESULTS: the performance of the post-COVID-19 group was worse than the healthy group in both tests. In 6MWT, the distance walked by the post-COVID-19 group (423 ± 7) was 94 m less than the healthy group, and the number of climbed steps in the 6MST (121 ± 4) was 34 steps less than the healthy group. Both results were statistically significant (p < 0.001). There was a moderate positive correlation between the 6MST and 6MWT in walked distance versus steps number (r = 0.5, p < 0.001). In addition, there was a moderate correlation between the two tests in the post (HR, RR, SpO2, systolic blood pressure SBP, diastolic blood pressure DBP, dyspnea, and fatigue) with p < 0.001. CONCLUSIONS: Six-minute step tests produced similar cardiorespiratory responses when compared to a 6MWT. The 6MST can be used as an assessment tool for COVID-19 patients to evaluate their functional capacity and ADL.

Effect of Different Foot Orthosis Inverted Angles on Walking Kinematics in Females with Flexible Flatfeet.

Background: Although the inverted technique was shown to be more effective compared to other orthotic designs for the treatment of flatfeet, the biomechanical mechanisms underlying the therapeutic effect of the inverted angle orthoses is still unclear. Therefore, the aim of this study was to examine the effect of different inverted angles of foot orthoses on walking kinematics in females with flexible flatfeet. Methods: Thirty-one female adults with flexible flatfeet aged 18-35 years old participated in this study. Kinematic data of the hip, knee, and ankle were collected via BTS motion-capture system during walking under three test conditions in random order: with shoes only; with 15° inverted orthoses; and with 25° inverted orthoses. Results: Compared to the shoes only condition, both the 15° and 25° inverted orthotic conditions significantly decreased the maximum ankle plantarflexion angle during loading response, maximum ankle dorsiflexion angle during mid-stance, maximum ankle external rotation angle, and maximum ankle internal rotation angle. The maximum ankle plantarflexion angle at toe-off showed a significant decrease with the 25° inverted angle orthosis compared to both the 15° inverted angle and shoes only conditions. No significant differences were found in the knee kinematic variables, maximum hip extension angle, and maximum hip adduction angle between test conditions. Conclusion: Using inverted orthoses at 15° and 25° inverted angles resulted in significant changes in ankle joint kinematics during walking in female adults with flexible flatfeet. A 25° inverted angle orthosis significantly decreased ankle plantarflexion during push-off, potentially impacting gait mechanics. This suggests that a smaller inverted angle may be more effective for managing flexible flatfeet in female adults.

Barriers and facilitators of evidence-based physiotherapy practice in Iran: A qualitative study.

BACKGROUND: To facilitate evidence-based practice (EBP) in physiotherapy in Iran and guide future improvements, it is crucial to identify what barriers and facilitators exist in the current system from the physiotherapist's perspective. Therefore, the purpose of this study was to explore the barriers and facilitators of EBP in physiotherapy in Iran. METHODS: This qualitative study was conducted using a phenomenological approach from January to July 2023 in Iran. The sampling process started with a purposive approach, and then an attempt was made to identify and interview more potential samples with the snowball approach. Thematic analysis was used to analyse the collected qualitative data. RESULTS: 44 individuals, including 37 physiotherapists and seven faculty members, participated in this study. Several barriers and facilitators to evidence-based physiotherapy practice in Iran were found and then put into three themes: (1) individual factors, (2) practice environment factors, and (3) extra-organisational factors. The most common barriers were time/workload pressures, financial incentives, lack of motivation, weakness in English, managers' pressures, inadequate awareness among patients, infrastructure limitations, poor economic situation, Internet restrictions, inappropriateness of the educational curriculum, difficult access to scientific research, and lack of insurance coverage for up-to-date therapies. CONCLUSIONS: Although most of the participants had a very positive view of physiotherapy based on scientific evidence, various obstacles have prevented this approach from being well implemented in Iran. Therefore, it is necessary to move towards minimising the existing barriers at the individual, practice environment, and extra-organisational levels by adopting effective multilateral policies.

Knowledge, Attitude, Practice, and Fear of COVID-19: an Online-Based Cross-cultural Study.

The study aimed to measure Knowledge, Attitude, and Practice (KAP) and fear level towards COVID-19 and explore its cross-cultural variances in knowledge by sociodemographic factors among the general population of 8 different countries over 5 continents. It was a cross-sectional online survey. This survey was conducted in April 2020 among 1296 participants using the "Google Form" platform. Considering the social distancing formula and pandemic situation, we collect data using popular social media networks. Univariate and bivariate analyses were used to explore the collected data on KAP, fear, and sociodemographic factors. Overall knowledge score was 9.7 ± 1.7 (out of 12), and gender differences (female vs male: 9.8 ± 1.6 vs 9.5 ± 1.9) were significant (p = 0.008) in the bivariate analysis. Knowledge score variances were found significant in some regions by gender, marital status, and education qualification. The highest and lowest mean knowledge scores were recorded in the Middle East (10.0 ± 1.7) and Europe (9.3 ± 2.0). Despite having a high fear score (22.5 ± 5.6 out of 35), 78.35% of respondents were positively and 81.7% in a good practice level. Fear score rankings: Middle East (1st; 23.8 ± 5.5), Europe (2nd; 23.2 ± 5.8), Africa (3rd; 22.7 ± 5.0), South Asia (4th; 22.1 ± 5.7), Oceania (5th; 21.9 ± 5.8), and North America (6th; 21.7 ± 5.5). Fear and knowledge were not correlated. KAP and fear variation exist among geographical regions. Gender, marital status, and education qualification are factors in knowledge variances for some regions. KAP and fear measures can help health education programs consider some sociodemographic factors and regions during an outbreak of highly contagious disease and uplift a positive attitude and good practice. Supplementary Information: The online version contains supplementary material available at 10.1007/s11469-021-00638-4.

Patient and public involvement in research: a review of practical resources for young investigators.

Patient and public involvement (PPI) in every aspect of research will add valuable insights from patients' experiences, help to explore barriers and facilitators to their compliance/adherence to assessment and treatment methods, bring meaningful outcomes that could meet their expectations, needs and preferences, reduce health care costs, and improve dissemination of research findings. It is essential to ensure competence of the research team by capacity building with available resources on PPI. This review summarizes practical resources for PPI in various stages of research projects-conception, co-creation, design (including qualitative or mixed methods), execution, implementation, feedback, authorship, acknowledgement and remuneration of patient research partners, and dissemination and communication of research findings with PPI. We have briefly summarized the recommendations and checklists, amongst others, for PPI in rheumatic and musculoskeletal research (e.g. the European Alliance of Associations for Rheumatology (EULAR) recommendations, the Core Outcome Measures in Effectiveness Trials (COMET) checklist and the Guidance for Reporting Involvement of Patients and the Public (GRIPP) checklist). Various tools that could be used to facilitate participation, communication and co-creation of research projects with PPI are highlighted in the review. We shed light on the opportunities and challenges for young investigators involving PPI in their research projects, and have summarized various resources that could be used to enhance PPI in various phases/aspects of research. A summary of web links to various tools and resources for PPI in various stages of research is provided in Additional file 1.

Caregiver Perspectives on Physiotherapy Treatment for Paediatric Burns in the United Arab Emirates.

Background: Physiotherapy is an essential component of paediatric burn treatment. Children are admitted to the paediatric burn unit with their caregivers who play a vital role in supporting the child's post-burn physiotherapy management. Objective: The objective of the study is to determine caregivers' attitudes on physiotherapy treatment for children with burns in the UAE. This study focused on the caregiver's perspective on five important domains: caregiver's knowledge, burden, attitude, adherence to physiotherapy exercise program, and caregiver's satisfaction. Methods: A descriptive cross-sectional study was conducted using self-administered questionnaire. Fifty caregivers were eligible to participate in the study. The analyses of the survey responses were done using SPSS software. Descriptive analysis and correlation statistics were used to present the data. Results: The caregiver participants in the study reported to have reasonably good knowledge about the paediatric burns care (13.62 ± 3.49) and had a positive attitude towards the physiotherapy treatment provided to the children with the burn injuries (9.41 ± 1.56). The adherence to the prescribed exercise regimen of physiotherapy sessions was found to be good (11.88 ± 1.50) but were overburdened with the caregiving tasks (21.42 ± 11.62). The study demonstrated very high levels of satisfaction among the caregivers with the physiotherapy treatment sessions provided to the children (13.4 ± 1.83). Conclusion: Caregiver attitude regarding physiotherapy management was overall positive; caregivers were well aware of the importance of physiotherapy and have reported high levels of satisfaction with the paediatric burn physiotherapy management.

Validity and Diagnostic Accuracy of the Clarke's Angle in Determining Pediatric Flexible Flatfoot Using Radiographic Findings as a Criterion Standard Measure: A Cross-sectional Study.

BACKGROUND: Clinical diagnosis of pediatric flexible flatfoot is still a challenging issue for health-care professionals. Clarke's angle (CA) is frequently used clinically for assessing foot posture; however, there is still debate about its validity and diagnostic accuracy in evaluation of static foot posture especially in the pediatric population, with some previous studies supporting and others refuting its validity. The present study aimed to investigate the validity and diagnostic accuracy of the CA using radiographic findings as a criterion standard measure to determine flexible flatfoot between ages 6 and 18 years. METHODS: A cross-sectional study of 612 participants (1224 feet) with flexible flatfoot aged 6 to 18 years (mean ± SD age, 12.36 ± 3.39 years) was recruited. The clinical measure results were compared with the criterion standard radiographic measures and displayed on the receiver operating characteristic curve, and the area under the curve was computed. Intrarater reliability, sensitivity, specificity, predictive values, and likelihood ratios were calculated for the CA. A Fagan nomogram was used to detect post-test probability. RESULTS: The CA demonstrated higher intrarater reliability (intraclass correlation coefficient = 0.997), sensitivity (98.4%), specificity (98.8), positive predictive value (97.3), negative predictive value (99.3), positive likelihood ratio (84), and negative likelihood ratio (0.02). The area under the curve was 0.98. The positive likelihood ratio yielded a post-test probability of 97%, and the negative likelihood ratio yielded a post-test probability of 0.02. CONCLUSIONS: The CA is a valid measure with high diagnostic accuracy in the diagnosis of flexible flatfoot between ages 6 and 18 years.

Influence of Effective Microorganisms on Some Biological and Biochemical Aspects of Spodoptera littoralis (Boisduval) (Lepidoptera: Noctuidae).

The cotton leafworm, Spodoptera littoralis (Bosid.), is a major pest in African and Asian nations that attacks a wide variety of host plants. This study was conducted to assess the effectiveness of effective microorganisms (EMs) on the biological and physiological features of S. littoralis larvae. Five concentrations (100, 200, 300, 400, and 500 ppm) of EMs were tested. Antifeedant activity, food consumption index, the efficiency of converting digested food, the efficiency of converting ingested food, relative growth rate, and approximate body tissue of the fourth larval instar of S. littoralis were determined. Moreover, carbohydrate enzyme activities (amylase, trehalose, and invertase), total protein, and total lipids of S. littoralis larvae were measured to elucidate the mode of action of the tested agent in the S. littoralis's larval stage. The EMs at 500 ppm had a substantial impact on antifeedant activity, nutritional indices, egg deposit reduction, and hatchability in S. littoralis during the five days. All concentrations interrupted S. littoralis's life cycle and developmental phases. Furthermore, all concentrations were quite useful in lengthening the developmental stages of S. littoralis. In addition, Ems affected the biochemical activities of larvae, leading to disturbances in carbohydrate, lipid, and protein levels. From this study, EMs can be used as a bioinsecticide alternative to traditional insecticides against S. littoralis and may be compatible with integrated pest management approaches.

Prevalence of Upper Limb Musculoskeletal Disorders and Their Association with Smartphone Addiction and Smartphone Usage among University Students in the Kingdom of Saudi Arabia during the COVID-19 Pandemic-A Cross-Sectional Study.

This study aimed to investigate the prevalence of upper limb musculoskeletal disorders (MSDs) and their association with smartphone addiction and smartphone usage among university students in the Kingdom of Saudi Arabia during the COVID-19 pandemic. A total of 313 university students aged 18 years and older who owned a smartphone and used it during the preceding 12 months participated in this cross-sectional study. The prevalence of upper limb MSDs, smartphone addiction/overuse, and levels of physical activity were recorded using the standardized Nordic musculoskeletal questionnaire, the smartphone addiction scale (short version), and the international physical activity questionnaire (short form), respectively. Data collection was performed on campus between March and May 2021. Binary logistic regression was used to determine the association between the prevalence of upper limb MSDs and smartphone addiction/overuse and levels of physical activity. The 12-month prevalence of MSDs of the shoulder, elbow, and wrist/hand regions due to smartphone use among participants was found to be 20.13%, 5.11%, and 13.42%, respectively. Shoulder (odds ratio (OR) = 11.39, 95% confidence interval (CI) = 4.64−27.94, p < 0.001), elbow (OR = 15.38, 95% CI = 1.92−123.26, p = 0.01), and wrist/hand MSDs (OR = 7.65, 95% CI = 2.75−21.22, p < 0.001) were more prevalent among participants who were categorized as having smartphone addiction/overuse measures. Promoting awareness about the healthy use of smartphones, including postural education and decreasing screen time, is necessary to reduce smartphone-related MSDs.

Evidence-based practice by physiotherapists in UAE: Investigating behavior, attitudes, awareness, knowledge and barriers.

Evidence-based practice (EBP) is an important factor determining the quality of healthcare. The field of physiotherapy is still limited by indirect access in several countries including the United Arab Emirates (UAE) which creates added pressure to justify the merit in its practitioner's capabilities. This study explores the behavior, attitudes, awareness and knowledge towards EBP among practicing physiotherapists in the UAE. It also enquires about their perception of the barriers in the implementation of EBP. Using a questionnaire survey of 258 physiotherapists, results show that the awareness of EBP is limited to a few terms including EBP, systematic literature review, and random trials while other terms associated with scientific studies are not known well. The attitude towards EBP was found to be significantly related to the knowledge of EBP (r = 0.208) and the perception of barriers to it (r = 0.156). The EBP behavior was found positively related to its knowledge (r = 0.134) and the perception of barriers (r = 0.216). The physiotherapists prefer to use their own experience and books and research articles to apply EBP but do not consider their peers to be as worthy sources as the others. However, their attitudes towards EBP are largely positive though their perception of barriers grows with better knowledge and understanding of EBP. The barriers in the implementation of EBP are a lack of research knowledge and skills, time, support, and resources which indicate opportunities for the decision-makers to improve the adoption of EBP among these professionals. This study concluded that although physiotherapists in the UAE claim awareness about EBP, their knowledge is limited to a few key terms whereas, attention is needed to improve EBP knowledge and practice.

Physiotherapists' perspectives on barriers to implementation of direct access of physiotherapy services in the United Arab Emirates: A cross-sectional study.

BACKGROUND: There are two primary ways of accessing physiotherapy for service users around the world. The direct access, as opposed to the indirect access which requires a referral from a general physician, has several merits including better quality, timeliness, cost effectiveness of treatment and better probability of preventing acute conditions from turning into chronic ailments. Despite these benefits, several countries including the UAE, do not allow direct access to physiotherapists. This study aims to understand the level of awareness among practicing physiotherapists in the United Arab Emirates (UAE) about direct access and to determine whether any of their demographic variables influence the way they perceive the concept. Further, the study sought to explore the perceived barriers and benefits of direct access according to the participating physiotherapists. SUBJECTS AND METHODS: An observational cross-sectional study was employed. The questionnaire survey developed by Bury and Stokes in 2013 was adapted and employed in this study. The instrument had six sections with close-ended items using a Likert five-point scale to rate them. Two hundred and sixty-four physiotherapists answered the questionnaire shared with them through a web link. Finally, MANOVA was employed to explore any influence of demographic variables on the opinions of the respondents. RESULTS: The findings showed that 70% of participants were aware about direct access while nearly 30% were completely unaware. Younger physiotherapists were more willing to endorse the practice whereas older ones were more apprehensive of the barriers. The main barriers reported were the limited support from the physicians and policy makers, professional autonomy, and the limited scope of practice for the physiotherapists, as well as evidence-based practice. The impact of demographic variables on direct access indicated that physiotherapists under the age of 23 endorsed direct access more strongly than other age groups. CONCLUSION: More efforts are needed to implement direct access in the UAE, considering the benefits of improved professional status, cost savings, patient satisfaction, and higher efficiency. This study recommends leadership support, professional autonomy, and mentorship as possible ways to achieve this goal.

Comparing Validity and Diagnostic Accuracy of Clarke's Angle and Foot Posture Index-6 to Determine Flexible Flatfoot in Adolescents: A Cross-Sectional Investigation.

OBJECTIVE: Clinically, the foot posture index-6 (FPI-6) and Clarke's angle (CA) are widely utilized to assess static foot posture; however, due to scarcity of scientific evidence, clinicians continue to debate the validity and diagnostic accuracy of these measures in children and adolescents. This study aimed to evaluate and compare the validity and diagnostic accuracy of the FPI-6 and CA in determining adolescents' flexible flatfoot between ages of 12 and 18 years, considering radiographic investigation as a reference standard measure. DESIGN: Cross-sectional study. SETTING: Governmental hospitals. PARTICIPANTS AND METHODS: A sample of 460 people (920 feet) with flexible flatfoot between the ages of 12 and 18 (15.23 ± 0.84 years) was enrolled in the study. The findings of the investigated measures were compared to the reference standard radiographic measure and plotted on the receiver operating characteristic (ROC) curve. The area under the ROC curve (AUC) was determined as a measure of FPI-6 and CA diagnostic accuracy. Intra-rater reliability, sensitivity, specificity, predictive values, and likelihood ratios of FPI-6 and CA were calculated and compared. The post-test probability of flatfoot was determined using the Fagan nomogram. RESULTS: CA had a substantially higher intra-rater reliability (ICC=0.99) than the FPI-6 (ICC=0.96), with p-value of 0.001. CA has greater sensitivity (98%) than FPI-6, as well as a superior specificity (99%), positive predictive value (98%), negative predictive value (98.9%), positive likelihood ratio (97), and a lower negative likelihood ratio (0.02). CA had such an area under ROC curve of 0.98 with a 95% confidence interval of 0.95-1.00, while FPI-6 had an area under ROC curve of 0.80 with a 95% confidence interval of (0.77-0.85). CONCLUSION: FPI-6 and Clarke's angle are both valid and diagnostically accurate clinical tests for flatfoot detection, with Clarke's angle outperforming FPI-6 in adolescents aged 12 to 18 years with a normal BMI.