Comparison of the physiotherapy with and without focus on the scapulothoracic joint on pain, range of motion, functional disability, quality of life, and treatment effectiveness of patients after arthroscopic shoulder rotator cuff tendon repair: A randomized controlled trial with short-term follow-up.

BACKGROUND: Rotator cuff tears are prevalent shoulder injuries, significantly affecting shoulder stabilization and patient quality of life. Despite rehabilitation efforts post-arthroscopic surgery, the efficacy of scapular-focused exercises remains uncertain with limited supportive evidence. PURPOSE: This study aimed to compare the immediate and short-term effects of emphasizing scapulothoracic joint rehabilitation in addition to conventional physiotherapy on pain, range of motion (ROM), function, quality of life, and treatment effectiveness in patients after shoulder arthroscopic rotator cuff tendon repair (ARCR). STUDY DESIGN: Two arms, parallel-group, randomized controlled trial, with concealed allocation METHODS: This parallel-group randomized controlled trial, with concealed allocation, was conducted in a clinic setting on 28 participants aged 30-75 years, exhibiting progressive degenerative full-thickness tears of rotator cuff muscles and undergoing ARCR, provided the tear size was small or medium. Participants were randomly allocated to receive 21 sessions of conventional rehabilitation (n = 14) or comprehensive rehabilitation (with a focus on scapula training; n = 14) in 12 weeks (reporting of intervention complied with Consensus on Exercise Reporting Template (CERT) and Template for Intervention Description and Replication (TIDieR) Guideline). Pain (as primary outcome), ROM, functional disability, quality of life, and treatment effectiveness were assessed both pre- and post-intervention, along with a 3-month follow-up. Participants, assessors, and statistician were blinded to group assignment. For the reporting of the RCT, the Consolidated Standards of Reporting Trials (CONSORT) has been used. RESULTS: Trial was completed with 28 participants and no dropouts. The analysis of variance revealed statistically significant group-by-time interaction (p < 0.05) for all outcome measures except for active ROMs (p > 0.05). Multiple comparison analysis showed statistically significant between-group differences (p < 0.05) at 3-month follow-up with large effect size (>0.8 Hedges' g) for all outcomes (mean differences: visual analog scale: 1.3, American Shoulder and Elbow Surgeons: -17.3, Shoulder Pain and Disability Index: 17.6, Western Ontario Rotator Cuff: -19.5, QuickDASH: 17.8), except for extension ROM (passive ROM: confidence interval = -25.4 to 0.56; active ROM: confidence interval = -20.0 to 6.0). The differences in American Shoulder and Elbow Surgeons and Western Ontario Rotator Cuff were also clinically significant based on their minimally clinical important difference cutoff points. For the Global Rating of Change scale, more participants stated "much improved" in the comprehensive group than in the conventional. No adverse effects were reported. CONCLUSIONS: Comprehensive rehabilitation, compared to conventional physiotherapy, has shown a statistically and clinically significant difference in improving pain, ROM, functional disability, quality of life, and treatment effectiveness in patients after ARCR.

Cross-cultural adaptation, validation and responsiveness of the Persian version of Western Ontario shoulder instability index questionnaire in Persian patients with shoulder instability.

INTRODUCTION: To translate, cross-culturally adapt, and psychometric testing the Western Ontario Shoulder Instability index (WOSI) into Persian. METHODS: Seventy-two patients diagnosed with shoulder instability participated in reliability, construct validity, and responsiveness analysis. All the patients filled out the WOSI with an interval of two weeks to assess reliability. The shortened Disability of Arm, Shoulder and Hand (Quick-DASH), Shoulder Pain and Disability Index (SPADI), and the 36-Item Short-Form Survey (SF-36) were assessed to evaluate construct validity. In order to assess responsiveness patients filled out WOSI before and after the physiotherapy and global rating of change scale at last session of physiotherapy. Reliability was assessed by intra-class correlation coefficient (ICC (1,2)), construct validity by two tailed Pearson (r), and responsiveness by longitudinal validity and receiver operating characteristics (ROC) curve analysis. RESULTS: The ICC (1,2) was 0.90 and correlation analysis revealed high level of correlation with: Quick-DASH (r = 0.82); SPADI (r = 0.72); physical SF-36 (r = -0.52); and mental SF-36 (r = -0.48). Responsiveness analysis demonstrated the area under curve was 0.90, with minimal clinical important difference 46.87. CONCLUSION: We found the Persian-WOSI as a valid, reliable, and responsive questionnaire to evaluate quality of life of patients with shoulder instability.

The effectiveness of comprehensive physiotherapy compared with corticosteroid injection on pain, disability, treatment effectiveness, and quality of life in patients with subacromial pain syndrome: a parallel, single-blind, randomized controlled trial.

OBJECTIVE: Comparing short- and long-term effects of comprehensive physiotherapy (CP) and subacromial corticosteroid injection (SCI) on pain, disability, and quality of life in the patients with subacromial pain syndrome (SAPS). DESIGN: 2 × 4 randomized controlled trial. PARTICIPANTS: 50 participants with unilateral SAPS. INTERVENTION: Random assignment with allocation concealment into two groups labeled as 12 sessions, supervised CP (n = 22) and 1cc triamhexal SCI (n = 25). OUTCOMES: Visual Analog Scale (VAS), Shoulder Pain and Disability Index (SPADI), shortened Disabilities of Arm, Shoulder and Hand (Quick-DASH), and Western Ontario Rotator Cuff Index (WORC). Outcomes were gathered pre- and post-intervention, with three- and six-month follow-ups. RESULTS: Variance analysis revealed that there was a significant interaction of group-in-time for SPADI and WORC (P < .05) but not for Quick-DASH and VAS (P > .05). The independent t-test analysis showed that the mean scores of all outcome measures in CP group were lesser than SCI group via 6 months (P < .05), except for the VAS (P > .05, mean difference = -0.97, 95% confidence interval -2.11-0.15). CONCLUSION: CP results in statistically significant and potentially clinically important difference in function and quality of the life at all timeframe. Moreover, there was no between group difference in order to reduce pain.

Comparing the effect of physiotherapy and physiotherapy plus corticosteroid injection on pain intensity, disability, quality of life, and treatment effectiveness in patients with Subacromial Pain Syndrome: a randomized controlled trial.

PURPOSE: To compare the short and medium-term effects of physiotherapy plus corticosteroid injection (combined) with physiotherapy alone on pain intensity, disability, Quality of Life (QoL), and treatment effectiveness in patients with Subacromial Pain Syndrome (SAPS). METHODS: In this double-blind, parallel Randomized Controlled Trial (RCT), 50 patients with SAPS were randomly assigned into combined (N = 25, a single injection 3-6 days before physiotherapy) and physiotherapy alone group (N = 25). Pain, disability, QoL, and treatment-effectiveness were measured at pre-intervention, post-intervention, and 3 and 6-month follow-up with Visual Analog Scale (VAS), Shortened Disability of the Arm, Shoulder, and Hand (Quick-DASH), Shoulder Pain and Disability Index (SPADI) (primary outcome measure), Western Ontario Rotator Cuff (WORC), and Global Rating of Change (GRC) respectively. A 2 × 4 (group × time) mixed model analysis of variance (ANOVA) was applied for analysis. RESULTS: The ANOVA revealed statistically significant group-in-time interaction for all outcome measures (p-value < 0.05). The independent t-test showed more effectiveness in the combined group at medium-term, as the mean scores of almost all outcome measures were substantially lesser (p < 0.01). Moreover, in short-time, despite a greater number of patients stating "completely recovered" in the combined group, there was no statistically significant difference between groups. CONCLUSIONS: Effects of physiotherapy plus corticosteroid injection could be more long-lasting than physiotherapy alone in improving pain intensity, disability, QoL, and treatment effectiveness in patients with SAPS. TRIAL REGISTRATION NUMBER: IRCT20201010048980N1.IMPLICATIONS FOR REHABILITATIONShoulder pain is common, persistent, and predominantly results from subacromial pain syndrome (SAPS).Physiotherapy and corticosteroid injections are effective interventions for this condition.Comprehensive physiotherapy alone can be as effective as corticosteroid injection combined with physiotherapy in the short term.A combined approach versus physiotherapy alone may have more medium-term effects on SAPS patients' pain, disability, quality of life, and treatment effectiveness.

Examining the diagnostic accuracy of common physical examination and functional tests in the diagnosis of patellofemoral pain syndrome among patients with anterior knee pain.

PURPOSE: The aims of this study were to evaluate the diagnostic accuracy of common physical examination and functional evaluation tests, and to determine a set of tests with the highest diagnostic accuracy for diagnosing patellofemoral pain syndrome (PFPS) in patients with anterior knee pain. METHODS: Based on careful evaluation of clinical findings and imaging methods by orthopedic physicians, 162 patients with anterior knee pain were classified into two groups of PFPS and non-PFPS. The physical examination and functional tests were performed by two physiotherapists. The accuracy of these measures was determined by calculating sensitivity, specificity, area under the receiver operating characteristic (ROC) curve (AUC), likelihood ratio (LR), and predictive value (PV). RESULTS: Our results showed the most sensitive tests in identifying patients with PFPS were as follows: eccentric step test [0.82 (95%CI: 0.72-0.89)]; palpation test [0.81(95%CI: 0.70-0.88)]; and prolonged sitting [0.73 (95%CI: 0.62-0.82)]. The palpation test, patellar tilt test, eccentric step test, navicular drop test, squatting, and stair descending tests had an acceptable accuracy (AUC ≥ 70). The strongest combination of the physical examination and functional tests included pain severity between 3 and 10 during stair descending test and pain severity between 6 and 10 during prolonged sitting test. This combination showed a positive LR of 19.47 (95% CI: 6.36-59.65) and a posttest probability of 95%. CONCLUSION: Our findings provide evidence for the good accuracy of the palpation test, patellar tilt test, eccentric step test, navicular drop test, squatting, and stair descending and prolonged sitting tests for diagnosing PFPS. Also, the combination of stair descending test and prolonged sitting test could be very useful for ruling in PFPS patients.

Responsiveness and minimal important changes of the OARSI core set of performance-based measures in patients with knee osteoarthritis following physiotherapy intervention.

PURPOSE: The Osteoarthritis Research Society International has recommended a core set of performance-based tests of physical function for use in knee osteoarthritis (OA) patients. The core set includes 30-second chair stand test (30-s CST), 4 × 10 m fast-paced walk test (40-m FPWT), and a stair climb test. This study aimed to evaluate responsiveness and minimal important changes (MICs) of these performance-based measures in knee OA patients following physiotherapy. METHODS: Sixty patients with knee OA, undergoing 4-week physiotherapy performed 30-s CST, 40-m FPWT, and 4-step stair climb test (4-step SCT) at pre- and post-intervention. Patients also completed the 7-point global rating scale as an external anchor at post-intervention. Responsiveness was evaluated using receiver operating characteristics curve and correlation analysis. RESULTS: All three performance-based measures of physical function showed area under the curve > 0.70. Correlation analysis showed relationship of 30-s CST, 40-m FPWT, and 4-Step SCT with the external anchor fell within moderate to good range (Spearman = 0.43-0.63). Furthermore, MIC values reflecting improvement for 30-s CST, 40-m FPWT, and 4-Step SCT were 2.5, 0.21, and 3.21, respectively. CONCLUSION: Our findings demonstrated all three performance-based measures have good responsiveness to measure improvement in physical functions of knee OA patients following physiotherapy. The MIC reflecting improvement can help clinicians and researchers to make a decision based on the clinical significance of improvements in patients' functional status.

Shoulder and scapula muscle training plus conventional physiotherapy versus conventional physiotherapy only: a randomized controlled trial of patients with lateral elbow tendinopathy.

BACKGROUND: Previous studies have suggested that weakening of shoulder and scapula muscles have been associated with increased pain, and decreased functional abilities in patients with lateral elbow tendinopathy (LET). PURPOSE: To compare the effects of shoulder and scapula muscle training plus conventional physiotherapy with conventional physiotherapy only. METHODS: A group of 48 patients with LET was randomly allocated into two groups: shoulder and scapula muscle training plus conventional physiotherapy (n = 24), and conventional physiotherapy (n = 24). All patients received 12 sessions of treatment for 4 weeks. Furthermore, both groups were instructed to continue their own exercise program at home until four months after the end of treatment. Pain intensity, grip strength, and functional status were measured preintervention, postintervention, and 4 months after the end of intervention (4-month follow-up). RESULTS: The shoulder and scapula muscle training plus conventional physiotherapy group showed significantly more reduction in pain and greater improvement in functional status compared with conventional physiotherapy group, but there was no significant difference in pain-free grip strength for two groups. CONCLUSION: Conventional physiotherapy combined with shoulder and scapula muscle training could be more effective in improving the pain and functional abilities of patients with LET compared with conventional physiotherapy only.

Post-operative fracture risk assessment following tumor curettage in the distal femur: a hybrid in vitro and in silico biomechanical approach.

The distal femur is the predominant site for benign bone tumours and a common site for fracture following tumour removal or cementation. However, the lack of conclusive assessment criterion for post-operative fracture risk and appropriate devices for cement augmentation are serious concerns. Hence, a validated biomechanical tool was developed to assess bone strength, depending on the size and location of artificially created tumorous defects in the distal femora. The mechanics of the bone-cement interface was investigated to determine the main causes of reconstruction failure. Based on quantitative-CT images, non-linear and heterogeneous finite element (FE) models of human cadaveric distal femora with simulated tumourous defects were created and validated using in vitro mechanical tests from 14 cadaveric samples. Statistical analyses demonstrated a strong linear relationship (R2 = 0.95, slope = 1.12) with no significant difference between bone strengths predicted by in silico analyses and in vitro tests (P = 0.174). FE analyses showed little reduction in bone strength until the defect was 35% or more of epiphyseal volume, and reduction in bone strength was less pronounced for laterally located defects than medial side defects. Moreover, the proximal end of the cortical window and the most interior wall of the bone-cement interface were the most vulnerable sites for reconstruction failure.

Investigation on distal femoral strength and reconstruction failure following curettage and cementation: In-vitro tests with finite element analyses.

Cement augmentation following benign bone tumor surgery, i.e. curettage and cementation, is recommended in patients at high risk of fracture. Nonetheless, identifying appropriate cases and devices for augmentation remains debatable. Our goal was to develop a validated biomechanical tool to: predict the post-surgery strength of a femoral bone, assess the precision and accuracy of the predicted strength, and discover the mechanisms of reconstruction failure, with the aim of finding a safe biomechanical fixation. Tumor surgery was mimicked in quantitative-CT (QCT) scanned cadaveric human distal femora, and subsequently tested in compression to measure bone strength (FExp). Finite element (FE) models considering bone material non-homogeneity and non-linearity were constructed to predict bone strength (FFE). Analyses of contact, damage, and crack initiation at the bone-cement interface (BCI) were completed to investigate critical failure locations. Results of paired t-tests did not show a significant difference between FExp and FFE (P > 0.05); linear regression analysis resulted in good correlation between FExp and FFE (R2 = 0.94). Evaluation of the models precision using linear regression analysis yielded R2 = 0.89, with the slope = 1.08 and intercept = -324.16 N. FE analyses showed the initiation of damage and crack and a larger cement debonding area at the proximal end and most interior part of BCI, respectively. Therefore, we speculated that devices that reinforce critical failure locations offer the most biomechanical advantage. The QCT-based FE method proved to be a reliable tool to predict distal femoral strength, identify some causes of reconstruction failure, and assist in a safer selection of fixation devices to reduce post-operative fracture risk.

The Relationship between Depression or Anxiety Symptoms and Objective and Subjective Symptoms of Patients with Frozen Shoulder.

BACKGROUND: the aim of this study is to evaluate the prevalence and effect of depression and anxiety on the shoulder range of motion, as well as the objective and subjective symptoms in patients suffering from frozen shoulder. METHODS: Between 2013 and 2014, in a cross-sectional study, we evaluated 120 patients with idiopathic frozen shoulder. We collected the demographic data for each patient and measured shoulder range of motion in four directions in both limbs. All patients filled out visual analog scale (VAS) for pain and the disabilities of the arm, shoulder, and hand (DASH) questionnaires. Both Hamilton anxiety and depression questionnaires were filled out for each patient. RESULTS: A total of 92 patients (77%) with idiopathic frozen shoulder showed symptoms of depression, while only 32 (27%) of them experienced anxiety. Thirty-two patients (27%) showed symptoms of both depression and anxiety. Although elevation and abduction were not affected by depression, internal and external rotations were more restricted among patients who had symptoms of depression. DASH and VAS scores were higher in patients with symptoms of depression. In terms of anxiety, only VAS and DASH were different between two groups. In multivariable analysis, DASH score was correlated with severity of both anxiety and depression symptoms. CONCLUSION: While there is no definitive relationship between symptoms of depression or anxiety and shoulder range of motion in patients suffering from frozen shoulder, patients who suffer from depression or anxiety experienced increased pain and limb disability.

Translation and Cross-cultural Adaptation of the Hip Disability and Osteoarthritis Score into Persian Language: Reassessment of Validity and Reliability.

BACKGROUND: This study aimed Persian translation and validation of the hip disability and osteoarthritis outcome score (HOOS) questionnaire. METHODS: The study was carried out in two phases. First, we translated the HOOS according to acceptable guidelines. We assessed HOOS content convergent validity on 203 hip osteoarthritis patients using SF-36. Internal consistency was tested using Cronbach's alpha coefficient if each item removed and intraclass correlation coefficient (ICC) for the assessment of test-retest reproducibility. RESULTS: Patients had mean (standard deviation) age of 39 (17). Test-retest ICC in whole was 0.95 (P = 0.014) showing excellent reliability. ICC was 0.92 for the "pain" subscale (P = 0.02), 0.81 for the "symptom" subscale (P = 0.002), 0.81 for the "function of daily living (FDL)" (P = 0.022), 0.88 for the "function of sports and recreational activities" (P = 0.006), but it was 0.62 (P = 0.1) for the "quality of life (QOL)." Cronbach's alpha was 0.92, 0.73, 0.97, 0.86, 0.80, and 0.80 for the pain, symptom, FDL, function of sports, QOL, and stiffness, respectively, showing good to excellent internal consistancy. Having SF-36 for the assessment of convergent validity, there was a strong correlation between total HOOS score and the physical component summary domain of SF-36 (r = 0.64, P = 0.0001), whereas the t correlation with the mental component summary domain was weak (r = 0.16, P = 0.04). CONCLUSIONS: The Persian version of the HOOS questionnaire is a valid (regarding physical not mental aspects) and reliable assessment tool in patients with hip osteoarthritis.

Poly (d/l) lactide/polycaprolactone/bioactive glasss nanocomposites materials for anterior cruciate ligament reconstruction screws: The effect of glass surface functionalization on mechanical properties and cell behaviors.

In this paper, different nanocomposites made of a polymer blend (80% of PDLLA and 20% of PCL in w/w) and various amounts of a sol-gel derived bioactive glass nanoparticles (0, 1, 3 and 6wt%) were prepared using a solvent-evaporation technique. The morphology, mechanical properties and osteoblastic cell behaviors of the nanocomposites were evaluated. According to the early results, addition of bioactive glass nanoparticles to the polymer matrix reduced the tensile and flexural strength because of a non-uniform distribution of the nanoparticles. Thus, a homogeneous dispersion was obtained by surface modification of the glass nanoparticles using (3-aminopropyl)triethoxysilane as a coupling agent. The results showed that the tensile and flexural strength of the nanocomposite were improved by the nanoparticle functionalization, however the glass content was a crucial factor. The maximum tensile and flexural strength values of 38MPa and 94MPa were obtained for the polymer matrix loaded with 3wt% of the modified nanofiller and further increase of filler content led to sever agglomeration and hence a reduction of the mechanical properties. The obtained mechanical properties are favorable for anterior cruciate ligament reconstruction screws. Besides, the results of cell culture using human osteoblastic cells illustrated better cell attachment and cell growth of the nanocomposites compared to the neat polymer blend.

Microstructure and mechanical properties of biodegradable poly (D/L) lactic acid/polycaprolactone blends processed from the solvent-evaporation technique.

In this study, polymer blends comprising poly(D/L) lactic acid (PDLLA) and 0-30wt% polycaprolactone (PCL) was prepared by a solvent-evaporation technique. The effect of PCL content on the dynamic-mechanical properties and tensile and flexural characteristics of the blends was evaluated. The creep and stress relaxation behaviors were also determined and using various known models such as power law, Burgers model and Weibull distribution equation. The results showed that by increasing the PCL content from 10 to 30wt%, the yield stress and flexural strength decreased from 47MPa to 26MPa and 72MPa to 29MPa respectively. In addition to tensile and flexural strength, the elastic modulus of neat PDLLA declined with increasing the PCL content, whereas the elongation or the strain percentage at the break point increased considerably. Biphasic regions were observed in the microstructures of the blends, indicating the immiscibility of PCL in PDLLA matrix. However, the PCL spherulites with an average particle diameter of 100nm to 5µm were homogeneously dispersed in PDLLA phase even at high PCL concentrations. Moreover, the microstructures of the fractured surfaces of the polymers confirmed that PDLLA with a brittle fracture behavior tends toward a soft fracture behavior when it is blended with PCL. The dynamic-mechanical tests indicated that the damping energy and dissipative ability of PDLLA improve by adding PCL. Moreover, Tg of neat PDLLA by adding of 10, 20 and 30wt% decreases from 67.3 to 66.2, 65.1 and 63.5°C respectively. Increasing in the recovered viscoelastic strain due to the addition of PCL was also experienced which can be attributed to the presence of large volumetric backbone of PCL chains as well as easy movement of them in the matrix. The results of modeling studies showed a good correlation between the experimentally obtained data.

Quality of life of caregiver spouses of veterans with bilateral lower extremity amputations.

BACKGROUND: Providing care for patients with chronic disability affects caregivers' social lives and relationships and can lead to poor health and lower quality of life. OBJECTIVES: In this study, our goal was to assess the quality of life in spouses of war veterans with bilateral lower limb amputations to find factors affecting caregivers' quality of life. PATIENTS AND METHODS: In a cross-sectional study, spouses of 244 veterans with war-related bilateral lower limb amputations for at least one year were invited to participate in this study; 189 couples accepted to participate. Information about age, gender, education level, duration of time since amputation, duration of care provided by the spouses and SF-36 questionnaire for both veterans and their spouses were collected. RESULTS: The average age of spouses was 47 years and duration of care provided by spouses was 25 years. We found lower scores for general health domains in amputees' spouses compared to the general population. Factors correlated with both Physical Component Summary (PCS) and Mental Component Summary (MCS) included the duration of care, duration of marriage, spouses' education level and the veterans' PCS and MCS scores. Veterans' age, spouses' age and the number of children only correlated with PCS. Veterans' education level only correlated with MCS. In multivariable analysis, only spouses' education level correlated with MCS and the veterans' PCS only correlated with that of spouses. CONCLUSIONS: The quality of life of amputees and their spouses were closely correlated; therefore, any improvement in one is likely to improve the other. In addition, lower education level should be considered as a risk factor for poorer quality of life in amputees' spouses.

Clinical instability of the knee and functional differences following tibial plateau fractures versus distal femoral fractures.

BACKGROUND: Fractures of the knee account for about 6% of all trauma admissions. While its management is mostly focused on fracture treatment, it is not the only factor that defines the final outcome. OBJECTIVES: This study aimed to study objective and subjective outcomes after proximal tibial versus distal femoral fractures in terms of knee instability and health-related quality of life. PATIENTS AND METHODS: This retrospective, cross-sectional, cohort study was carried out on 80 patients with either isolated proximal tibial (n = 42) or distal femoral (n = 38) fractures, who underwent open reduction and internal fixation. All the fractures were classified based on the Schatzker and AO classification for tibial plateau and distal femoral fractures, respectively. The patients were followed and examined by an orthopedic knee surgeon for clinical assessment of knee instability. In their last follow-up visit, these patients completed a Lysholm knee score and the short-form (SF) 36 health survey. RESULTS: Among the 42 tibial plateau fractures, 25% were classified as Schatzker type 2. Of the 38 distal femoral fractures, we did not find any type B1 or B3 fractures. The overall prevalence of anterior and posterior instability was 42% and 20%, respectively. Medial Collateral Ligament (MCL) and Lateral Collateral Ligament (LCL) injuries were detected clinically in 50% and 28%, respectively. The incidence rates of ligament injuries in tibial plateau fractures were as follows: Anterior Collateral Ligament (ACL) 26%, Posterior Collateral Ligament (PCL) 7%, MCL 24%, and LCL 14%. Medial collateral ligament injury was the most common in the Schatzker type 2 (50% of the injuries). Distal femoral fractures were associated with ACL injury in 16%, PCL in 13%, MCL in 26% and LCL in 14%. However, final knee range of motion (ROM) and function (Lysholm score) were not associated with fracture location. No statistically significant difference was observed between the two groups, except for the valgus stress test at 30°knee flexion, which was more positive in tibial fractures. All eight domains of SF-36 score in the distal femoral and proximal tibial fractures were significantly different from the normal values; however, there were no statistically significant differences between femoral and tibial fracture scores. CONCLUSIONS: Although ROM is acceptable in knee joint fractures, instability is common. However, it seems that knee function and quality of life are not associated with the location of the fracture.

Ponseti casting for severe club foot deformity: are clinical outcomes promising?

Between 2007 and 2010, a prospective study was done on 85 patients with severe idiopathic nonsyndromic clubfeet, in our center. Demographic features, severity of the deformity before and after serial casting according to Diméglio classification, and complications were assessed. The mean age of the patients was 8 days and 69% were male. The mean follow-up period was 26 months. The average number of castings used to correct the deformity was 5.7 times (range: 4 to 8). Tenotomy was performed in 76 (89.4%) of the feet. In all patients, plantigrade foot was achieved. Tenotomy occurred more in patients with higher Diméglio scores. Although patients who underwent Achilles tenotomy began to walk later than those who did not (13 ± 7.2 versus 9.2 ± 18), it was not significant (P = 0.06). Relapse rate, at the end of follow-up, was 27.1%. Diméglio score before casting was 16 ± 3.4 and at the end of follow-up it was 1.6 ± 6.2. The patients with bilateral clubfeet had inferior final outcome compared to those with unilateral clubfoot. Eighty percent of parents' were completely satisfied with their child's gait and foot appearance (94.1%). Ponseti method of manipulation and casting is a valuable technique in severe club foot as well as in common types.

Long-term clinical outcomes of war-related bilateral lower extremities amputations.

In a cross-sectional study, 291 out of 500 veterans with war-related bilateral lower limb amputations from Iran-Iraq war (1980-1988) accepted to participate in our study. Information related to amputees and amputated limbs were gathered and a Persian version of the Medical Outcomes Study Short Form 36 (SF-36) was filled. To evaluate the effect of amputation level on health related quality of life, we classified patients to seven types according to the functional remainder of major joints (ankles, knees, hips). 97% of patients were male and the average age at the time of injury was 20 years. The major cause of war injury was shells in 50. 54% of amputees were involved in sport activities. The most common amputation level was transtibial (48%).The major stump complaint was muscle spasm. History of being hospitalized for a psychiatric disorder was reported in 5.6%. The average SF-36 score in type 2 to type 6 were 68, 60, 60, 56, and 62, respectively. Except Energy/Fatigue domain, all the other domains were different from normal population. There was not any significant statistical correlation between amputation type and any domain of the SF-36. Type 6 amputees showed an increase in physical health domains compared with former types.

The International Knee Documentation Committee (IKDC) Subjective Short Form: a validity and reliability study.

PURPOSE: The purpose of the present research was to translate the original English version of International Knee Documentation Committee (IKDC) Subjective Short Form to Persian and to assess validity and reliability of it in Iranian patients with ACL injury. METHOD: The Persian version of the IKDC Subjective Short Form was administered to 145 patients including 111 men (76 %) and 34 women (24 %) with the clinical diagnosis of knee ACL tear that were referred to our Knee and Shoulder Center at Mashhad University of Medical Sciences, Mashhad, Iran. The Persian IKDC Subjective Short Form and Persian SF-36 questionnaire were completed by patients in the clinic before beginning any treatment intervention. Patients filled out the Persian IKDC 72 h again before receiving a major treatment; we were then able to use the test-retest method to calculate reliability. RESULTS: The average age of the subjects was 30.9 ± 10.4 years. The calculated ICC with 95 % confidence interval was 0.845. In this study, Cronbach's alpha was 0.845. There were significant correlations between mean total score of the Persian IKDC and all items of the SF36 (P < 0.05) except for MCS (P = 0.055). CONCLUSION: Cronbach's alpha and correlation of IKDC Subjective Short Form and SF-36 demonstrated that the Persian version of IKDC has both strong reliability and validity. The Iranian version of IKDC has favourable validity and reliability and therefore can be used to assess Persian-speaking patients with cruciate ligament injuries. LEVEL OF EVIDENCE: Level II.

Cross-cultural adaptation and validation of the persian version of the oxford knee score in patients with knee osteoarthritis.

BACKGROUND: The Oxford Knee Score (OKS) is a short patient-reported outcome instrument that measures pain and physical activity related to knee osteoarthritis. The purpose of this study is to evaluate, construct validity and consistent reliability of the Persian version of the OKS. METHODS: The case series consisted of 80 patients who were clinically diagnosed with having knee osteoarthritis. All patients were requested to fill-in the Persian OKS and Short-Form 36 Health Survey (SF-36). Correlation analysis between the Persian versions of these two instruments was then carried out. The scores of the Persian SF-36 were used to evaluate convergent and divergent validity of the 12-item Persian OKS. RESULTS: From a total of 80 patients, 63 were female (79%) and the remaining 17 were male (21%) with a mean age of 52.2 years. In the present study, high Cronbach's alpha of 0.95 confirms excellent internal consistency of the Persian OKS scale similar to previous investigations. The results confirm that the Persian version of this instrument is valid and reliable, similar to its English index and its subsequent translations in different languages. CONCLUSION: The Persian OKS is a reliable instrument to evaluate knee function in patients with knee osteoarthritis and is a useful tool for outcome measurement in clinical research.

Quality of life among veterans with chronic spinal cord injury and related variables.

BACKGROUND: In recent decades, the incidence of spinal cord injuries has increased. In a systemic review on epidemiology of traumatic spinal cord injury in developing countries reported 25.5/million cases per year. OBJECTIVES: To assess the quality of life (QOL) of the veterans among Iran-Iraq war with chronic spinal cord injuries (SCI) and to evaluate long-term impressions of SCI on their quality of life. PATIENTS AND METHODS: Fifty-two veterans, all male, with chronic spinal cord injury from Iran-Iraq war (1980-1988) were interviewed and examined. The mean age of veterans at the time of interview was 49.3 years (38 to 80 years). Veterans were assessed by using a 36-item short-form (SF-36), hospital anxiety and depression scale (HADS) and the Barthel index. The presence or absence of pressure sores and spasticity were documented as well. RESULTS: The mean age of veterans at the time of study was 49.3 years. Pearson's correlation test showed that depression and anxiety have a reverse association with mental component summary (MCS) scale and physical component summary (PCS) scale scores, respectively. Regression analysis showed a negative effect of depression and pressure sore on PCS. Moreover, no association was found between the duration of injury and age with quality of life. CONCLUSIONS: Lower QOL was found among veterans with chronic SCI. More researches on health-related quality of life (HRQOL) are needed to give us a better understanding of changes in life of patients with SCI and the ways to improve them.