Comparison of simultaneous bilateral versus unilateral total knee replacement on pain levels and functional recovery.

BACKGROUND: Total knee replacement is a common operative procedure to improve pain, function, and quality of life in patients with end stage knee osteoarthritis. The current study aimed to compare simultaneous bilateral versus unilateral total knee replacement on pain intensity and recovery of function. METHODS: A total of 80 patients (bilateral 50, unilateral 30) aged 63.28 (9.4) years undergone total knee replacement participated in the current study. The participants were admitted for 5-7 days in the hospital. Participants in both the group received similar inpatient and outpatient physiotherapy sessions. Pain intensity and function capacity were assessed at baseline, day 7, and day 30 postoperatively using visual analogue scale and lower extremity functional scale, respectively. Repeated measures analysis of variance was used to analyze the data. RESULTS: Both groups showed a significant reduction of pain intensity (Day 0, mean 8.9, SD 1.0; Day 30, mean 2.2, SD 1.3 in bilateral total knee replacement; Day 0, mean 8.8, SD 1.1; Day 30, mean 2.0, SD 1.5 in unilateral total knee replacement; p < 0.001) and improvement in the functional capacity (Day 0, mean 16.2, SD 10.1; Day 30, mean 55.6, SD 14.6 in bilateral total knee replacement; Day 0, mean 19.1, SD 9.1; Day 30, mean 56.7, SD 15.8 in unilateral total knee replacement; p < 0.001) following total knee replacement at 30 days post-operatively. However, there was a non-significant difference noted between bilateral versus unilateral total knee replacement on the reduction of pain intensity (mean changes, 6.9 versus 6.8) and improvement in the functional capacity (mean changes, 39.4 versus 37.6) at 30 days post-operatively (p > 0.05). CONCLUSION: Simultaneous bilateral total knee replacement was associated with a similar reduction of pain intensity and recovery of function compared to unilateral total knee replacement, suggesting the use of simultaneous bilateral total knee replacement in patients with bilateral knee osteoarthritis since its costs and rehabilitation process could be reduced compared to staged bilateral total knee replacement.

Psychometric properties of the perceived stress scale in Ethiopian university students.

BACKGROUND: Stress is a common psychological condition usually associated with many psycho-physical disorders. Stress and its risk factors are frequently seen in Ethiopians including university students. In such circumstances, a valid measure to screen for stress in Ethiopians is necessary. Therefore, we assessed the psychometric properties of the Perceived Stress Scale (PSS) in Ethiopian university students. METHODS: A cross-sectional study with a simple random sampling method was performed on students of Mizan-Tepi University, Mizan-Aman, Ethiopia. The study presents a psychometric investigation on a sample of 387 students (age = 21.8 ± 3.8 years, and body mass index = 20.8 ± 3.2 kg/m2) who completed PSS, Generalized anxiety disorder-7 scale (GAD-7), and a socio-demographics tool. McDonald's Omega (internal consistency), factor validity for ordinal data and convergent validity (Spearman's correlation) were assessed. RESULTS: No ceiling/floor effect was seen for the total or factor scores of the PSS-10 and PSS-4. Two factor model of the PSS-10 was favored by fit indices with Comparative Fit Index> 0.95, Weighted root mean square residual<.05 and root mean square error of approximation<.08. McDonald's Omega was 0.78 and 0.68 for the PSS-10: Factor-1 and PSS-10: Factor-2, respectively. McDonald's Omega was 0.70 and 0.54 for the PSS-4: Factor-1 and PSS-4: Factor-2, respectively. There were moderate-strong correlations (r = 0.62-0.83) between PSS factors and respective items loading on them. PSS scores were correlated with GAD-7 (r = .27-.40, p < .01). CONCLUSION: The psychometric measures support the validity of the PSS-10 in Ethiopian university students.

Effect of 6-week retro or forward walking program on pain, functional disability, quadriceps muscle strength, and performance in individuals with knee osteoarthritis: a randomized controlled trial (retro-walking trial).

BACKGROUND: Previous studies reported the beneficial effects of walking in individual with mild to moderate knee osteoarthritis (OA). The current study aimed to compare the effect of 6-week retro versus forward walking program versus control group on pain, functional disability, quadriceps muscle strength and physical performance in individuals with knee OA. METHODS: A three-arm single-blinded, randomized, controlled trial and intention-to-treat analysis was conducted in outpatient physiotherapy department, King Saud University, Saudi Arabia. Sixty-eight individuals (mean age, 55.6 years; 38 female) with knee OA participated. The participants in the retro or forward walking group completed 10 min of supervised retro or forward walking training in addition to usual care, 3 days/week for 6 weeks. The control group received a routine physiotherapy program. This program comprises a combination of closed and open kinematic chain exercises, including straight leg raising, isometric quadriceps, isometric hip adduction, terminal knee extension, semi-squat, and leg press. The primary outcomes were mean pain and knee function score measured by the numerical rating scale and the Western Ontario and McMaster Universities Osteoarthritis Index, respectively. The secondary outcomes were mean score of quadriceps muscle strength and timed up and go test scores. All the outcomes were analyzed at baseline and week 6. RESULTS: In total, 68 subjects participated in this 6-week randomized, controlled trial. The completion rates of the primary and secondary outcome measures at week 6 were 91, 87, and 82% in the retro walking, forward walking, and control groups, respectively. In the intention-to-treat analysis, the retro walking group had a greater reduction in pain intensity (mean changes, 1.8 versus 1; p = 0.01) and functional disability (mean changes, 4.8 versus 2.2; p = 0.008) than the control group. Similarly, the retro walking group had a greater improvement in the quadriceps muscle strength (mean changes, 1.7 kg versus 0.7 kg; p = 0.008) and the timed up and go test (mean changes, 0.6 s versus 0.1 s; p = 0.003) than the control group. CONCLUSIONS: The 6-week retro walking program compared with forward walking or control groups resulted in greater reduction in pain and functional disability and improved quadriceps muscle strength and performance in individuals with knee OA. TRIAL REGISTRATION: Controlled Trials ISRCTN12850845 , Registered 26 January 2015.

Reliability, validity, and responsiveness of three scales for measuring balance in patients with chronic stroke.

BACKGROUND: Various outcome measures are used for the assessment of balance and mobility in patients with stroke. The purpose of the present study was to examine test-retest reliability, construct validity, and responsiveness of the Timed Up and Go Test (TUG), Berg Balance Scale (BBS), and Dynamic Gait Index (DGI) for measuring balance in patients with chronic stroke. METHODS: Fifty-six patients (39 male and 17 female) with chronic stroke participated in this study. A senior physical therapist assessed the test-retest reliability and validity of three scales, including the DGI, TUG, and BBS over two testing sessions. In addition, the third assessment of each scale was taken at the time of discharge to determine the responsiveness of the three outcome measures. RESULTS: The reliability of the TUG (intraclass correlation coefficient [ICC2,1] = 0.98), DGI (ICC2,1 = 0.98) and BBS (ICC2,1 = 0.99) were excellent. The standard error of measurement (SEM) of the TUG, DGI, and BBS were 1.16, 0.71, and 0.98, respectively. The minimal detectable change (MDC) of the TUG, DGI, and BBS were 3.2, 1.9, and 2.7, respectively. There was a significant correlation found between the DGI and BBS (first reading [r] = 0.75; second reading [r] = 0.77), TUG and BBS (first reading [r] = -.52; second reading [r] = -.53), and the TUG and DGI (first reading [r] = 0.45; second reading [r] = 0.48), respectively. CONCLUSIONS: The test-retest reliability of the TUG, BBS, and DGI was excellent. The DGI demonstrated slightly better responsiveness than TUG and BBS. However, the small sample size of this study limits the validity of the results.

Validation of the adapted Leeds sleep evaluation questionnaire in Ethiopian university students.

BACKGROUND: Current evidence supports the applicability of the Leeds Sleep Evaluation Questionnaire (LSEQ) in screening for insomnia. The psychometric properties of the LSEQ have never been investigated in an African population. Therefore, this study aimed to validate the adapted version of the LSEQ-Mizan (LSEQ-M) in Ethiopian university students. METHODS: Of a preliminary sample of 750 (random sampling), 424 students (age = 21.87 ± 4.13 years and body mass index = 20.84 ± 3.18 kg/m2) from Mizan-Tepi University, Mizan-Aman, South-west Ethiopia completed the LSEQ-M, the General Anxiety Disorder Scale-7 and a semi-structured questionnaire for socio-demographics. Insomnia was screened in accordance with the International Classification of Sleep Disorders as a measure of concurrent validity. RESULTS: Although, individual items showed ceiling and floor effect, the LSEQ-M as a scale did not have these effects. Good internal consistency (Cronbach's alpha of 0.84) and strong internal homogeneity as measured by the correlation coefficient between items scores and the LSEQ-M global score was found. The LSEQ-M showed excellent screening applicability for insomnia with optimal cut-off scores of 52.6 (sensitivity 94%, specificity 80%), and the area under the curve, 0.95 (p < 0.0001). The original 4-Factor model was valid in Ethiopian university students for screening for insomnia. CONCLUSION: The LSEQ-M has excellent psychometric validity in screening for insomnia among Ethiopian university students.

Effect of footwear on standing balance in healthy young adult males.

OBJECTIVE: The present study aimed to evaluate the effect of footwear on standing balance in healthy young adult males. METHODS: Thirty healthy male participants aged 20-30 years were tested for standing balance on the Balance Master on three occasions, including wearing a sandal, standard shoe, or no footwear (barefoot). The tests of postural stability include; "Modified Clinical Test of Sensory Interaction on Balance" (mCTSIB), "Unilateral Stance" (US), and the "Limits of Stability" (LOS). The balance scores (mCTSIB, US, and LOS) was analyzed. RESULTS: There was a significant effect between footwear conditions for mCTIB with eye closed on a firm surface (p=0.002). There was a significant effect between footwear conditions for the US with eye open and closed (p⟨0.05). There was a significant effect between footwear conditions for LOS reaction time during forward movement (p=0.02). Similarly, there was a significant effect between footwear conditions for LOS reaction time during left side movement (p=0.01). CONCLUSIONS: Wearing sandals compared to bare feet significantly increased postural sway and reduced stability in healthy young adult males. However, wearing a standard shoe compared to bare feet did not significantly affect balance scores in standing.

Effect of quadriceps and calf muscles fatigue on standing balance in healthy young adult males.

OBJECTIVE: The present study aimed to compare the effects of quadriceps or calf muscles fatigue on static and dynamic standing balance in young healthy adult males. METHODS: Forty-five healthy, physically active male adults aged 18-30 years were randomly divided into three groups; Quadriceps muscle fatigue group (n=15), Calf muscles fatigue group (n=15), and a control group (n=15). The Modified Clinical Test of Sensory Interaction on Balance, Unilateral Stance, and Limits of Stability (reaction time and movement velocity) were selected as outcome measures for this study. RESULTS: The results showed a non-significant difference between pretest and posttest balance scores (p>0.05) for quadriceps and calf muscles fatigue on balance. Similarly, there were non-significant differences in posttest balance scores when comparing fatigue effects between the groups (p>0.05). CONCLUSIONS: These results suggested that the fatigue of the quadriceps or calf muscles did not influence standing balance in healthy young adult males. Future longitudinal studies are recommended to further understanding the mechanisms behind localized muscle fatigue effects on standing balance in subjects of different age groups of both genders.

Implementation and use of standardized outcome measures by physical therapists in Saudi Arabia: barriers, facilitators and perceptions.

BACKGROUND: The use of standardized outcome measures (SOMs) has been recommended in the physical therapy practice guidelines to improve the patient's management and encourage the evidence based practice. However, the extent of the use of SOMs by physical therapists (PTs) in Saudi Arabia was not investigated. The present study aimed to (1) evaluate the extent of the use of SOMs by PTs in routine daily practice in Saudi Arabia; (2) explore the barriers, facilitators and perceptions in the use of SOMs during physical therapy services; (3) examine the relationship between facility settings and the PTs characteristics and the use of SOMs. METHODS: The present study used an observational design. A survey based questionnaire used and distributed to 352 PTs who were working in Saudi Arabia and was commonly involved in the management of patients within different clinical settings, either private or public. RESULTS: One-hundred-eighty participants completed the questionnaires (response rate of 51%). One-hundred-eleven (62%) participants indicated that they used SOMs in their practice. The most common barriers to using the SOMs were time-consuming for patients and therapist and difficult to understand the outcome measures by the patients. Those with a Masters degree were 3.5 times more likely to use SOMs compared to PTs with diploma level qualification [Odd Ratio (95% CI) 3.5 (0.9-12.6)]. Participants with a clinical specialty were nearly 3 times more likely to use SOMs than those who do not have a specialty [Odd Ratio (95% CI) 2.9 (1.6-5.5)]. CONCLUSIONS: Nearly two-thirds of the participants indicated that they used SOMs in clinical practice. Time-consuming for patient and therapist, difficult to understand the SOMs by the patients were the main perceived barriers. Years of experience, professional degree, and clinical specialty had a high probability of using SOMs. The majority of the participants showed the willingness to use SOMs in the future.

Cross-cultural adaptation and psychometric analysis of the Arabic version of the oxford knee score in adult male with knee osteoarthritis.

BACKGROUND: There are varieties of self-assessment questionnaire used for the evaluation of pain, functional disability, and health related quality of life in individuals with knee osteoarthritis (OA). The present study intended to adapt and translate the oxford knee score into the Arabic and investigated its psychometric properties in adult male with knee OA. METHODS: Ninety-seven adult male (mean age 57.55 ± 11.49 years) with knee OA participated. Patients were requested to complete the adapted Arabic version of the Oxford knee score (OKS-Ar), reduced "Western Ontario and McMaster Universities Index (WOMAC)", and the Visual analogue scale (VAS). Patients were requested to complete 2nd form of OKS-Ar at least 1 week apart to assess the reproducibility of the score. The OKS was adapted and translated into Arabic by two independent Arabic native speakers (one rehabilitation professional having experience of knee OA patients and another one a trained translator) according to the international guidelines. RESULTS: All the participants completed the 2nd form of OKS-Ar (Response rate 100%). Reliability and internal consistency was high with an ICC of 0.97, and the Cronbach's alpha coefficient of 0.987, respectively. A significant relationship between the OKS-Ar and the WOMAC and VAS scores confirmed the construct validity (p < 0.001). The standard error of measurement (SEM) and the minimum detectable change (MDC) were 2.2 and 6.2, respectively. CONCLUSIONS: The adapted Arabic version of the OKS demonstrated acceptable psychometric properties, including reliability, internal consistency, and the validity. The present study indicates that the OKS-Ar is a suitable questionnaire to measure pain and physical function in the Arabic speaking adult male patients with knee OA.

Effect of retro and forward walking on quadriceps muscle strength, pain, function, and mobility in patients with knee osteoarthritis: a protocol for a randomized controlled trial.

BACKGROUND: Walking, a closed kinetic chain (CKC) activity, is widely used in knee rehabilitation as it allows early weight bearing and movement. It has been suggested that retro-walking may provide additional benefits beyond those experienced by forward-walking. The present study will investigate the effect of retro- and forward-walking on quadriceps muscle strength, pain, function, balance and mobility in knee Osteoarthritis (OA) subjects. METHODS/DESIGN: Sixty-nine participants with knee OA will be recruited from the outpatient department in this randomized controlled trial. The participants will be randomly assigned to one of three groups; retro walking, forward walking or control group. The training program will be 3 days/week for 6 weeks. In addition, all the participants will receive a standard physiotherapy training program. An independent assessor blinded to group assignment will measure quadriceps muscle strength, knee pain intensity, functional disability, and mobility at baseline and 6 weeks after training. DISCUSSION: The results of this study will enhance our understanding on the therapeutic effects of walking (retro- or forward-walking) in knee OA. The findings from this study will help determine whether retro- or forward-walking or both are effective in the rehabilitation of subjects with knee OA. TRIAL REGISTRATION: Controlled Trials ISRCTN12850845, Registered 26 January 2015.

Comparison of the effect of pre- and post-operative physical therapy versus post-operative physical therapy alone on pain and recovery of function after total knee arthroplasty.

[Purpose] The aim of the present study was to compare the effect of pre-operative and post-operative physical therapy versus post-operative physical therapy alone on pain and recovery of function after total knee arthroplasty. [Subjects and Methods] Fifty patients (18 males and 32 females) ranging in age from 48 to 80 years (mean 63.28, SD 9.44) participated in a 6-week two-arm randomized rater-blinded trial. One group received pre- and post-operative physical therapy whereas the other group received only post-operative physical therapy. Pain and function were measured with a visual analogue scale and a lower extremity functional scale at baseline (pre-operative) as well as week 3 and week 6 post-operative. [Results] The differences in pain intensity and functional score at week 3 and week 6 post-operative remained statistically insignificant between the two groups. [Conclusion] The reduction of pain and recovery of function was similar in subjects who received pre- and post-operative physical therapy and those who received only post-operative physical therapy after total knee arthroplasty. Additional pre-operative physical therapy did not bring about any further improvement in pain intensity or recovery of function after total knee arthroplasty.

Effect of absence of vision on posture.

[Purpose] The visual system is one of the sensory systems that enables the body to assess and process information about the external environment. In the absence of vision, a blind person loses contact with the outside world and develops faulty motor patterns, which results in postural deficiencies. However, literature regarding the development of such deficiencies is limited. The aim of this study was to discuss the effect of absence of vision on posture, the possible biomechanics behind the resulting postural deficiencies, and strategies to correct and prevent them. [Subjects and Methods] Various electronic databases including PubMed, Medline, and Google scholar were examined using the words "body", "posture", "blind" and "absence of vision". References in the retrieved articles were also examined for cross-references. The search was limited to articles in the English language. [Results] A total of 74 papers were shortlisted for this review, most of which dated back to the 1950s and 60s. [Conclusion] Blind people exhibit consistent musculoskeletal deformities. Absence of vision leads to numerous abnormal sensory and motor interactions that often limit blind people in isolation. Rehabilitation of the blind is a multidisciplinary task. Specialists from different fields need to diagnose and treat the deficiencies of the blind together as a team. Before restoring the normal mechanics of posture and gait, the missing link with the external world should be reestablished.

Effects of two different mobilization techniques on pain, range of motion and functional disability in patients with adhesive capsulitis: a comparative study.

[Purpose] This study aimed to compare the effects of two different mobilization techniques in the management of patients with adhesive capsulitis. [Subjects and Methods] Thirty non-diabetic men and women with adhesive capsulitis were randomly allocated to the reverse distraction group (n=15) or Kaltenborn group (n=15). The reverse distraction technique and Kaltenborn's caudal and posterior glides (grades III and IV) were applied 10-15 times along with conventional physical therapy for 18 treatment sessions in 6 weeks. Pain was measured with a visual analog scale, abduction and external rotation range of motion with goniometry, hand behind back reach with inch tape, and functional disability with the Flexilevel scale of shoulder function before and after the treatment. [Results] Although all the variables improved significantly in both groups after 18 intervention sessions, reverse distraction was significantly better than Kaltenborn's caudal and posterior glides in decreasing pain and improving abduction range of motion and functional scores. [Conclusion] This study supports the clinical use of reverse distraction as an alternative to conventional mobilization techniques to decrease pain and improve range of motion and functional scores in patients with adhesive capsulitis.

Physical and balance performance following exercise induced muscle damage in male soccer players.

[Purpose] The present study aimed to determine the changes in physical and balance performance following exercise-induced muscle damage using a sport-specific protocol. [Subjects and Methods] Fifteen collegiate soccer players were asked to perform a sport-specific sprint protocol to induce muscle damage. The markers of muscle damage (soreness, range of motion, limb girth, muscle strength, creatine kinase and lactate dehydrogenase), physical performance (speed, agility and power) and balance (static and dynamic balance) were assessed at baseline and 24, 48 and 72 hours following the sprint protocol. [Results] All variables, including the markers of muscle damage, physical performance and balance showed a significant difference when assessed at the 4 time points. [Conclusion] The study demonstrated that both the physical and balance performance were affected following repeated sprint protocol in soccer players. It is recommended the balance performance of an athlete be continually assessed following exercise-induced muscle damage so as to determine the appropriate return to sport decision thereby, minimizing the risk of further injury.

The perceptions and readiness toward interprofessional education among female undergraduate health-care students at King Saud University.

[Purpose] Interprofessional education (IPE) is an important academic approach for preparing health-care professionals to provide patient care in a collaborative team environment. This study aimed to measure the perceptions and readiness toward IPE among female undergraduate health-care students at King Saud University (KSU). [Subjects and Methods] A cross-sectional study carried out using a survey in the form of an electronic questionnaire: The Readiness for Interprofessional Learning Scale (RIPLS). The questionnaire was distributed to the students via e-mail and social media networks. [Results] The RIPLS was completed by 296 female health-care students at KSU who valued the importance of IPE. The differences between health-care disciplines in the perceptions and readiness toward IPE were statistically significant, but there were no differences between students of different years of study in their perception and readiness toward IPE. [Conclusion] Administering a course of interprofessional teamwork in the health-care curriculum is a major challenge for the clinical education community. IPE offers an opportunity to address the multi-disciplinary concept in hospitals. Our findings indicate that undergraduate health-care students have high perception and readiness toward IPE.

Therapeutic effects of whole-body vibration training in knee osteoarthritis: a systematic review and meta-analysis.

OBJECTIVE: To examine the current evidence regarding the effects of whole-body vibration (WBV) training in individuals with knee osteoarthritis (OA). DATA SOURCES: We searched PubMed, CINAHL, Embase, Scopus, Physiotherapy Evidence Database (PEDro), and Science Citation Index for research articles published prior to January 2015 using the keywords whole body vibration, vibration training, and vibratory exercise in combination with the Medical Subject Heading osteoarthritis knee. STUDY SELECTION: This meta-analysis was restricted to randomized controlled trials published in the English language. The quality of the selected studies was assessed by the PEDro Scale. The risk of bias was assessed using the Cochrane collaboration's tool in the domain-based evaluation. We also evaluated the quality of each study based on the criteria given by the International Society of Musculoskeletal and Neuronal Interactions for reporting WBV intervention studies, consisting of 13 factors. DATA EXTRACTION: Descriptive data regarding subjects, design, intervention, WBV parameters, outcomes, and conclusions were collected from each study by 2 independent evaluators. The mean and SD of the baseline and final endpoint scores for pain, stiffness, and function were extracted from the included studies. DATA SYNTHESIS: A total of 83 studies were found in the search. Of these, 5 studies met the inclusion criteria and were further analyzed. Four of these 5 studies reached high methodologic quality on the PEDro Scale. Overall, studies demonstrated mixed results in favor of additive effects of WBV for reducing pain and improving function in knee OA. There was considerable variation in the parameters of the WBV included in this systematic review. CONCLUSIONS: WBV training reduces pain and improves function in individuals with knee OA.

The reliability and minimal detectable change of Timed Up and Go test in individuals with grade 1-3 knee osteoarthritis.

BACKGROUND: The Timed Up and Go (TUG) test is quick and easy tests to assess patients' functional mobility. However, its reliability in individuals with knee osteoarthritis (OA) has not been well established. The aims of this study were to determine the reliability and minimal detectable change of the TUG test in individuals with doubtful to moderate (Grade 1-3) knee OA. METHODS: Sixty-five subjects (25 male, 40 female), aged 45-70 years, with knee OA participated. Inter-rater reliability was assessed using two observers at different times of the same day in an alternating order. Intra-rater reliability was assessed on two consecutive visits with a 2-day interval. The standard error of measurement (SEM) and the minimum detectable change (MDC) were calculated to determine statistically meaningful changes. RESULTS: Intra-rater and inter-rater reliability were 0.97 (95% confidence interval [CI], 0.95 - 0.98) and 0.96 (95% confidence interval [CI], 0.94 - 0.97), respectively. The MDC, based on measurements by a single rater and between raters, was 1.10 and 1.14 seconds, respectively. CONCLUSIONS: The TUG is a reliable test with adequate MDC for clinical use in individuals with doubtful to moderate knee OA.

Prevalence of musculoskeletal pain in construction workers in Saudi Arabia.

The objective of this study was to find out the prevalence, characteristics, and distribution of musculoskeletal pain among construction workers in Saudi Arabia. A questionnaire about musculoskeletal pain in different parts of the body was completed by 165 construction workers from the construction industries in Dammam and Riyadh cities. The descriptive data were analyzed using chi-square test. The level of statistical significance was set at P < 0.05. Eighty (48.5%) of the responding workers had pain in neck, shoulders, lower back, hand, knee, or ankle. The majority of respondents had low back pain (50%) followed by knee pain (20%). The average intensity of pain at all sites during activity and rest was 6.65 and 3.59, respectively. Thirty-four (42.5%) respondents had dull aching pain and 24 (30%) had cramping pain. There was an association between years of experience, duration of break during work, and use of protective equipment with the prevalence of musculoskeletal pain in construction workers (P < 0.05). Most of the workers complaining of pain got medical treatment (62.5%) and only 25% received physical therapy. It can be concluded from this study that the prevalence of musculoskeletal pain among construction workers in Saudi Arabia is high.

Effect of modified hold-relax stretching and static stretching on hamstring muscle flexibility.

[Purpose] The aim of present study was to compare the effectiveness of modified hold-relax stretching and static stretching in improving the hamstring muscle flexibility. [Subjects and Methods] Forty-five male subjects with hamstring tightness were included in this study. The subjects were randomly placed into three groups: the modified hold-relax stretching, static stretching and control groups. The modified hold-relax stretching group performed 7 seconds of isometric contraction and then relaxed for 5 seconds, and this was repeated five times daily for five consecutive days. The static stretching group received 10 minutes of static stretching with the help of a pulley and weight system for five consecutive days. The control group received only moist heat for 20 minutes for five consecutive days. A baseline reading of passive knee extension (PKE) was taken prior to the intervention; rest measurements were taken immediate post intervention on day 1, day 3, day 5, and after a 1 week follow-up, i.e., at the 12th day. [Results] On comparing the baseline readings of passive knee extension (PKE), there was no difference noted between the three groups. On comparing the posttest readings on day 5 between the 3 groups, a significant difference was noted. However, post hoc analysis revealed an insignificant difference between the modified hold-relax stretching and static stretching groups. There was a significant difference between the static stretching and control groups and between the modified hold-relax stretching and control groups. [Conclusion] The results of this study indicate that both the modified hold-relax stretching technique and static stretching are equally effective, as there was no significant difference in improving the hamstring muscle flexibility between the two groups.

Physical therapy education in Saudi Arabia.

[Purpose] To review the physical therapy educational program model, professional curriculum, and gender representation at major universities, as well as the quality and scope of physical therapy practice in Saudi Arabia. [Methods] Information regarding course curriculum, gender representation, and the quality and scope of physical therapy practice was collected from six universities in Saudi Arabia, the Saudi Physical Therapy Association, and the Saudi Health Commission. [Results] The first bachelor's degree course of physical therapy was started in Saudi Arabia more than 30 years ago. In the last 10 years, the number of universities offering a bachelor's degree in physical therapy has risen from 6 to 16, of which 14 are governmental and two are private. The 5- to 6 year bachelor's degree program in physiotherapy includes an internship and preparatory prerequisite courses. Postgraduate study in physical therapy was introduced in 2000. Most universities offer segregated physical therapy courses for male and female students. [Conclusion] The enrollment of students in physical therapy programs in Saudi Arabia is gradually increasing. There are many opportunities to extend the scope of practice and contribute to the health needs of the Arab population and international communities.