The effect of movement system impairment-based classification treatment compared to routine physiotherapy on pain, disability, alignment, and movement impairments in individuals with tibiofemoral rotation syndrome: a randomized controlled trial.

BACKGROUND: Knee pain is a common musculoskeletal problem. Lower extremity movement impairments could alter stresses in different planes and contribute to knee pain. Classifying these impairments may be helpful in the diagnosis and treatment of knee problems. Movement system impairment (MSI)-based classification is a system to evaluate movement impairments. Trials that involve this classification are limited. Therefore, it will be of interest to examine the effect of movement system impairment-based classification treatment compared to routine physiotherapy in individuals with tibiofemoral rotation syndrome. METHODS: Twenty-two individuals with knee pain aged 18-40 years (2 males, 20 females) diagnosed with tibiofemoral rotation (TFR) syndrome were included. After initial evaluation, individuals were randomly assigned into two treatment groups (MSI-based treatment and routine physiotherapy). Both treatment groups contained 8 treatment sessions over 4 weeks. Alignment and movement impairments data form, a numeric rating scale (NRS), and the Kujala Disability Questionnaire were assessed at baseline and after a four-week intervention. Independent samples t-test and Mann-Whitney U test were used for quantitative variables, and Fisher's exact test was employed for qualitative variables to compare the groups. One-way Analysis of variance (ANOVA) and paired samples t-test were utilized to within-group changes of quantitative variables, and qualitative variables were analyzed with the McNemar test. RESULTS: The results showed that pain intensity and disability significantly decreased within and between groups after intervention (P > 0.05). There were also statistically significant differences between treatment groups for 3 out of 6 alignment and movement impairments (PS-FAdd/IR, Step down-Add/Valgus, and STS-Add/Valgus) (P > 0.05). Within-group differences for alignment and movement impairments were significant only for the MSI-based treatment group (P > 0.05). CONCLUSIONS: The findings suggest that a specific MSI-based treatment, considering a homogenous group of individuals with knee pain, may contribute to pain, disability, and alignment and movement impairments improvement. Therefore, it is important to notice the classification-based treatment for individuals with knee pain. TRIAL REGISTRATION NUMBER (TRN) AND DATE OF REGISTRATION: The trial was registered at the ( https://www.irct.ir ), (IRCT20210505051181N3) on 17/7/2021.

Could dry needling change the kinematics of gait in individuals with piriformis muscle syndromes? Secondary analysis of a randomized controlled trial.

INTRODUCTION: Piriformis muscle syndrome (PMS) is a condition that can lead to symptoms including gluteal pain, local tenderness, and limitation of hip joint motion in daily activities, and it may have a major impact on some daily functions such as gait. We proposed that dry needling (DN) can improve the gait of individuals with PMS. METHODS: Thirty-two individuals with PMS were assigned equally and randomly to the treatment group or the wait-list control group. Subjects in the treatment group received three sessions of DN of the piriformis muscle. All participants in both groups were educated to correct their lifestyles. The outcome measures were the gait-related parameters (walking speed, peak hip flexion, peak hip extension, time to peak internal and external hip rotation, and knee sagittal range of motion), which were evaluated at baseline and after treatment. To compare different outcomes, analysis of covariance (ANCOVA) was used, with baseline as the covariance and groups as a factor. RESULT: After DN sessions, peak hip extension during gait showed a statistically significant difference [adjusted MD 1.9 (3.7-0.08), p < 0.05, d = 0.56 (0.1-1.28)] in favor of the DN group. Peak hip flexion, on the other hand, exhibited a marginal statistically significant difference [adjusted MD -3.2 (-6.51 to 0.01), p = 0.053, d = 0.44 (1.16 to -0.02)] compared to the control group. CONCLUSION: The findings suggest that participants in DN showed significantly greater peak extension angle of the hip during walking in individuals with PMS than in the control group.

Prevalence of surgical site infection and risk factors in patients after knee surgery: A systematic review and meta-analysis.

The present systematic review and meta-analysis aimed to determine the prevalence of surgical site infection (SSI) and risk factors in patients after knee surgery. A comprehensive and systematic search was carried out across various international electronic databases, including Scopus, PubMed and Web of Science, as well as Persian electronic databases like Iranmedex and the Scientific Information Database (SID). This search involved the utilization of keywords derived from Medical Subject Headings, such as 'Prevalence', 'Surgical wound infection', 'Surgical site infection' and 'Orthopaedics', spanning from the earliest records up to 1 October 2023. To assess the quality of the included studies, the Appraisal tool for Cross-Sectional Studies (AXIS tool) was utilized. The study encompassed a combined participant pool of 11 028 individuals who underwent knee surgery across seven selected studies. The collective prevalence of SSI in patients who underwent knee surgery, as reported in the seven included studies, was determined to be 3.0% (95% CI: 1.2% to 7.5%; I2 = 96.612%; p < 0.001). The combined prevalence of SSI in patients with DM, as reported in six studies, was 5.1% (95% CI: 1.7% to 14.5%; I2 = 79.054%; p < 0.001). Similarly, the pooled prevalence of SSI in patients with HTN, drawn from four studies, was 1.8% (95% CI: 0.7% to 4.5%; I2 = 63.996%; p = 0.040). Additionally, the collective prevalence of SSI in patients with a history of tobacco use, based on findings from six studies, was 4.8% (95% CI: 1.4% to 15.2%; I2 = 93.358%; p < 0.001). Subgroup analysis was conducted within six studies, categorizing them by two countries, namely China and the USA. These analyses revealed that the prevalence of SSI following knee surgery was 3.0% in China and 2.0% in the USA. It is noteworthy that variations in SSI prevalence across different studies may be attributed to a multitude of factors, particularly varying risk factors among patient populations. To address this issue and mitigate the impact of SSI on knee surgery patients, it is advisable to develop tailored interventions.

Prevalence of anxiety and its risk factors in burn patients: A systematic review and meta-analysis.

The primary objective of this systematic review and meta-analysis was to ascertain the prevalence of anxiety and identify associated risk factors among individuals who have suffered burn injuries. We conducted a thorough and systematic search across various international electronic databases, including Scopus, PubMed and Web of Science, as well as Persian electronic databases like Iranmedex and the scientific information database (SID). Our search encompassed the period from the earliest available records up to 8 August 2023. We employed keywords derived from Medical Subject Headings (MeSH) such as "Prevalence", "Anxiety" and "Burns". In total, 2586 burn patients participated in 13 cross-sectional studies. The mean age of the participants was 32.88 (SD = 2.51). In a compilation of 13 studies, the documented overall occurrence rate of anxiety among burn patients stood at 16.1% (95% CI: 10.0% to 24.7%; I2 = 93.138%; p < 0.001). The outcomes of a meta-regression analysis, which examined the association between anxiety in burn patients and the year of publication, did not uncover any significant correlation (p = 0.442). Furthermore, there was a notable association between anxiety in burn patients and factors such as gender, TBSA affected, educational level and the types of burn injuries. Therefore, healthcare providers need to recognize the substantial prevalence of anxiety in burn patients as a fundamental consideration. This recognition should prompt a proactive approach toward early detection and timely intervention. Developing personalized intervention strategies tailored to each patient's unique risk factors and needs is paramount. These strategies may encompass a range of therapeutic options such as counselling, psychotherapy or consultations with mental health specialists.

The Correlation between Intersegmental Coordination Variability and Frontal Plane Hip Kinematics during Running in Persons with Patellofemoral Pain.

Background: Despite the existing evidence indicating altered hip kinematics as well as the studies showing altered movement coordination variability in persons with patellofemoral pain (PFP), there is no study investigating the correlation between hip joint kinematic and movement coordination variability in persons with patellofemoral pain (PFP). Objective: This study aims to evaluate the correlation between peak hip adduction and variability of thigh frontal-shank transverse coordination during running in persons with PFP. Material and Methods: In this cross-sectional correlational study, kinematic data were collected from 34 females (17 with and 17 without PFP) aged 18-35 years during treadmill running at preferred and fixed speeds, each for 30 s. The continuous relative phase method was used to calculate the coordination of thigh frontal-shank transverse. To calculate the deviation phase as the variability of intersegmental coordination, the standard deviation of the ensemble continuous relative phase curve points was averaged. The parameters of interest were peak hip adduction and coordination variability of thigh frontal-shank transverse. The Pearson Correlation Coefficient (r) was used to calculate the correlation between the variables. Results: The Pearson correlation coefficient showed a significant negative correlation between the peak hip adduction angle and variability of thigh frontal- shank transverse during running at both fixed (r=-0.553, P<0.05) and preferred (r=-0.660, P<0.01) speeds in persons with PFP while the control group showed a small nonsignificant correlation (r<0.29, P>0.05). Conclusion: The results indicated that greater adduction of the hip joint in persons with PFP during running is contributed to lesser variability of thigh frontal-shank transverse.

Effect of multidimensional physiotherapy on non-specific chronic low back pain: a randomized controlled trial.

BACKGROUND: Many people with non-specific chronic low back pain (NSCLBP) do not recover with current conventional management. Systematic reviews show multidimensional treatment improves pain better than usual active interventions. It is unclear whether multidimensional physiotherapy improves pain better than usual physiotherapy. This study determines the effectiveness of this treatment to reduce pain and disability and improve quality of life, pain cognitions, and electroencephalographic pattern in individuals with NSCLBP. METHODS: 70 eligible participants aged 18 to 50 years with NSCLBP were randomized into either the experimental group (multidimensional physiotherapy) or the active control group (usual physiotherapy). Pain intensity was measured as the primary outcome. Disability, quality of life, pain Catastrophizing, kinesiophobia, fear Avoidance Beliefs, active lumbar range of motion, and brain function were measured as secondary outcomes. The outcomes were measured at pre-treatment, post-treatment, 10, and 22 weeks. Data were analyzed using intention-to-treat approaches. RESULTS: There were 17 men and 18 women in the experimental group (mean [SD] age, 34.57 [6.98] years) and 18 men and 17 women in the active control group (mean [SD] age, 35.94 [7.51] years). Multidimensional physiotherapy was not more effective than usual physiotherapy at reducing pain intensity at the end of treatment. At the 10 weeks and 22 weeks follow-up, there were statistically significant differences between multidimensional physiotherapy and usual physiotherapy (mean difference at 10 weeks, -1.54; 95% CI, -2.59 to -0.49 and mean difference at 22 weeks, -2.20; 95% CI, - 3.25 to - 1.15). The standardized mean difference and their 95% confidence intervals (Cohen's d) revealed a large effect of pain at 22 weeks: (Cohen's d, -0.89; 95% CI (-1.38 to-0.39)). There were no statistically significant differences in secondary outcomes. CONCLUSIONS: In this randomized controlled trial, multidimensional physiotherapy resulted in statistically and clinically significant improvements in pain compared to usual physiotherapy in individuals with NSCLBP at 10 and 22 weeks. TRIAL REGISTRATION: ClinicalTrials.gov NCT04270422; IRCT IRCT20140810018754N11.

Coordination of the Lower Limbs of Soccer Players after Anterior Cruciate Ligament Reconstruction with Allograft and Autograft during Landing.

Objectives: Quantitative biomechanical tests, along with physical assessment, may be useful to understand kinematics associated with graft types in anterior cruciate ligament surgery, particularly in individuals aiming for a safe return to sport. Methods: Sixty male soccer players in three groups participated in this study. Three equal groups of healthy, auto transplanted and allotransplanted participants, matched for age, gender, activity level and functional status, landed with one foot on a force plate. Their kinematic information was recorded by the motion analyzer and used to describe coordination the variability by measuring coupling angles using vector coding. Results: The coordination variability of the allograft group in the surgical limb was significantly greater than that of the healthy group at least 9 months after the reconstructive surgery of the ACL and at the stage of return to sports, (F (6, 35) = 2.79, p = 0.025; Wilk's Λ = 0.676, partial η2 = 0.32). The coordination pattern in the surgical and healthy limbs of the surgical groups also differed from that of the healthy people, which was more pronounced in the allograft group, (F (6, 35) = 2.61, p = 0.034; Wilk's Λ = 0.690, partial η2 = 0.31). Conclusion: These results show that the allograft group has a different coordination variability at return to sport than the healthy group, so they may need more time for excessive training and competition.

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

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

Observational assessment for determining shoulder fault movements before and after corrective education in participants with chronic shoulder pain: Concurrent validity study.

BACKGROUND: Movement faults (MF), described as the alteration of joint position and motion, are an important factor associated with developing shoulder pathologies. However, determining or predicting the exact MF in participants with shoulder pain is limited by the absence of clinical tools and poor validity. PURPOSE: The aim of the study was to determine the validity of using observational assessment to MFs or controlling MFs in subjects with chronic shoulder pain during shoulder elevation and external rotation. STUDY DESIGN: Concurrent validity study METHODS: Twenty-seven people with chronic shoulder pain were examined. The index test represented three observational assessments of MF during shoulder external rotation, elevation in the frontal plane, and elevation in the sagittal plane. Three-dimensional motion analysis represented the reference test. The movements of both shoulder joints were evaluated simultaneously, and the index and reference tests were performed concurrently. RESULTS: The sensitivity and specificity of observational detection were good to excellent (Se: 77.5%, Sp: 81.5%) for MF and excellent (Se: 85.7%, Sp: 100%) for controlling MF. The positive and negative predictive value was (PPV: 93.9, NPV: 57.1) for MF and (PPV: 100%, NPV: 82.8%) for controlling MF. The result of the positive and negative likelihood ratio was (PLR: 5.4, NLR: 0.26) for MF and (PLR: 0, NLR: 0.18) for controlling MF. CONCLUSIONS: The results revealed that the validity of the observational detection approach for identifying MFs was good to excellent. Moreover, the accuracy of this approach in detecting the control of MFs after patient education was excellent. There was good to excellent accuracy in most MFs once classified by their motion trajectories, except for scapula anterior tilt during glenohumeral joint external rotation or elevation.

Walking Performance during Concurrent Cognitive and Motor Tasks in Individuals with Nonspecific Chronic Low Back Pain: A Case-Control Study.

Background: The present study aimed to compare the effects of simultaneous cognitive and motor tasks on walking performance between individuals with nonspecific chronic low back pain (NSCLBP) and healthy controls. Methods: A total of 20 patients with NSCLBP and 20 healthy controls participated in this study. They walked at their self-selected speed on a treadmill under 3 walking conditions in a randomized order: walking only, walking while performing a concurrent cognitive task, and walking while performing a concurrent motor task. Two-way repeated measure analysis of variance with additional post hoc comparison (Bonferroni test) was used to evaluate the effects of group and walking conditions on gait parameters. Results: The result showed a significant main effect of the group for swing time ( P = 0.012) and double support time (P = 0.021) in those with NSCLBP compared with healthy controls. Moreover, there was a significant interaction between the group and condition for cadence ( P = 0.004) and step width variability (P = 0.016).Regarding stride length variability and stride time variability, the analysis indicated a significant effect of condition (P = 0.002 and P = 0.030, respectively). In both groups, no significant differences were observed in gait parameters between motor dual task and single walking ( P > 0.05). Conclusion: Our findings indicated that those with NSCLBP adapted successfully to walking performance to maintain the performance of the concurrent cognitive task under the cognitive dual-task walking condition. Moreover, the present study observed no dual-task interference under the motor dual-task condition.

Neuropeptide Y directly reduced apoptosis of granulosa cells, and the expression of NPY and its receptors in PCOS subjects.

BACKGROUND: Most women with anovulatory infertility show polycystic ovarian syndrome (PCOS), and androgen excess is known as a key factor involved in pathogenicity of PCOS. However, the mechanism of follicular developmental arrest in PCOS is not completely understood. The reproductive function of Neuropeptide Y (NPY) in the ovary during folliculogenesis was previously reported; NPY function in apoptosis and proliferation of granulosa cells (GCs) is follicular-stage dependent. The objective of this study was to investigate the role of NPY in ovarian follicular development and the pathogenesis of PCOS. METHODS: To simulate the PCOS phenotype using a rat model, 21-day old Sprague Dawley rats were implanted with dihydrotestosterone (DHT) capsule (83 µg/day) and euthanized after 28 days. mRNA and protein content of NPY and its receptors were assessed in GCs from DHT treated rats using RT-qPCR and Western blot, respectively. Proliferation and apoptosis of GCs was assessed using Ki67- and TUNEL assays. Finally, NPY levels were measured in human follicular fluid (FF) from matched PCOS and non-PCOS patients using ELISA. RESULTS: GCs from DHT treated rats (PCOS-GCs) contained significantly less NPY protein and Npy mRNA by 0.16- and 0.56-fold, respectively, and more NPY receptor type 2 and 5 protein by 2.21- and 3.17-fold, respectively, when compared to sham control. Addition of recombinant NPY to PCOS-GCs culture did not alter Ki67-positive but significantly decreased TUNEL-positive cells by 0.65-fold, but not to baseline levels. There was no significant difference in NPY levels in FF between PCOS and non-PCOS subjects. CONCLUSIONS: These results indicate that DHT modulates expression of NPY and its receptors, NPY decreases DHT-induced GCs apoptosis. That alterations in NPY's function might be involved in follicular developmental failure of PCOS.

Obesity and PCOS radically alters the snRNA composition of follicular fluid extracellular vesicles.

Introduction: The ovarian follicle consists of the oocyte, somatic cells, and follicular fluid (FF). Proper signalling between these compartments is required for optimal folliculogenesis. The association between polycystic ovarian syndrome (PCOS) and extracellular vesicular small non-coding RNAs (snRNAs) signatures in follicular fluid (FF) and how this relates to adiposity is unknown. The purpose of this study was to determine whether FF extracellular vesicle (FFEV)-derived snRNAs are differentially expressed (DE) between PCOS and non-PCOS subjects; and if these differences are vesicle-specific and/or adiposity-dependent. Methods: FF and granulosa cells (GC) were collected from 35 patients matched by demographic and stimulation parameters. FFEVs were isolated and snRNA libraries were constructed, sequenced, and analyzed. Results: miRNAs were the most abundant biotype present, with specific enrichment in exosomes (EX), whereas in GCs long non-coding RNAs were the most abundant biotype. In obese PCOS vs. lean PCOS, pathway analysis revealed target genes involved in cell survival and apoptosis, leukocyte differentiation and migration, JAK/STAT, and MAPK signalling. In obese PCOS FFEVs were selectively enriched (FFEVs vs. GCs) for miRNAs targeting p53 signalling, cell survival and apoptosis, FOXO, Hippo, TNF, and MAPK signalling. Discussion: We provide comprehensive profiling of snRNAs in FFEVs and GCs of PCOS and non-PCOS patients, highlighting the effect of adiposity on these findings. We hypothesize that the selective packaging and release of miRNAs specifically targeting anti-apoptotic genes into the FF may be an attempt by the follicle to reduce the apoptotic pressure of the GCs and stave off premature apoptosis of the follicle observed in PCOS.

Granulosa cell-derived miR-379-5p regulates macrophage polarization in polycystic ovarian syndrome.

Polycystic ovarian syndrome (PCOS) is associated with hyperandrogenemia and ovarian antral follicle growth arrest. We have previously demonstrated that androgen-induced exosomal release of miR-379-5p (miR379) from preantral follicle granulosa cells increases the proliferation of target cells via phosphoinositide-dependent kinase 1 (PDK1) upregulation. Androgen also increases inflammatory M1 macrophage abundance, but reduces anti-inflammatory M2 polarization in rat antral and preovulatory follicles. However, the role of small extracellular vesicles (sEVs; also known as exosomes) secretion in determining the cellular content and function of miRNAs in exosome-receiving cells is largely unknown. Our objectives were to determine: 1) the regulatory role of granulosa cells (GC)-derived exosomal miR379 on macrophage polarization and ovarian inflammation; 2) whether miR379-induced M1 polarization regulates GC proliferation; and 3) if this regulated process is follicular stage-specific. Compared with non-PCOS subjects, PCOS subjects had a higher M1/M2 ratio, supporting the concept that PCOS is an inflammatory condition. Ovarian overexpression of miR379 increased the number of M1 macrophages and the M1/M2 ratio in preantral follicles specifically. Transfection of macrophages with a miR379 mimic reduced the cellular content of PDK1 and induced M0→M1 polarization; whereas its inhibitor polarized M0→M2. Conditioned media from macrophages transfected with miR379 mimic and follicular fluid from PCOS subjects had higher galectin-3 content, a pro-inflammatory cytokine which specifically suppresses human antral follicle GC proliferation. These results indicate that miR379 inhibits M2 macrophage polarization, a condition which suppresses GC proliferation in a follicle stage-dependent manner, as exhibited in PCOS.

Androgen-induced exosomal miR-379-5p release determines granulosa cell fate: cellular mechanism involved in polycystic ovaries.

Polycystic ovarian syndrome (PCOS) is a complex multi-factorial syndrome associated with androgen excess and anovulatory infertility. In the current study, we investigated the role of dihydrotestosterone-induced exosomal miR-379-5p release in determining the destiny of the developing follicles. Our hypothesis was that androgen regulates granulosa cell miR-379-5p content by facilitating its exosomal release in a follicular-stage dependent manner, a process which determines granulosa cell fate. Compared to human non-PCOS subjects, individuals with PCOS exhibit higher follicular fluid free testosterone levels, lower exosomal miR-379-5p content and granulosa cell proliferation. Androgenized rats exhibited lower granulosa cell miR-379-5p but higher phosphoinositide-dependent kinase-1 (PDK1; a miR-379-5p target) content and proliferation. Androgen reduced granulosa cell miR-379-5p content by increasing its exosomal release in preantral follicles, but not in antral follicles in vitro. Studies with an exosomal release inhibitor confirmed that androgen-induced exosomal miR-379-5p release decreased granulosa cell miR-379-5p content and proliferation. Ovarian overexpression of miR-379-5p suppressed granulosa cell proliferation, and basal and androgen-induced preantral follicle growth in vivo. These findings suggest that increased exosomal miR-379-5p release in granulosa cells is a proliferative response to androgenic stimulation specific for the preantral stage of follicle development and that dysregulation of this response at the antral stage is associated with follicular growth arrest, as observed in human PCOS.

Reliability of Ultrasound Measurements of the Lumbar Multifidus and Transversus Abdominis Muscles during Lying and Unstable Sitting Positions in Individuals With and Without Chronic Low Back Pain.

Background: The reliability studies are limited to support ultrasound usage during dynamic conditions; for example, unstable sitting position. Objective: This study aims to examine the reliability of ultrasound measurements of the lumbar multifidus and transversus abdominis during lying and unstable sitting positions in individuals with chronic low back pain (CLBP) and asymptomatic individuals considering abnormal lumbar lordosis. Material and Methods: In this observational study, intrarater within-day and between-day reliability of muscle thickness and contraction ratio of the lumbar multifidus and transversus abdominis muscles were assessed using ultrasound imaging. In total, 40 participants (27 with CLBP, 13 asymptomatic individuals) with abnormal lumbar lordosis were recruited. The degree of lumbar lordosis has been measured by a flexible ruler. The muscle thickness was assessed at lying and sitting on a gym ball for both muscles in three sessions. Results: Both groups had well to high ICCs of thickness measurement and contraction ratio in the transversus abdominis and lumbar multifidus muscles during both static (ICC=0.71-0.99) and semi-dynamic conditions (ICC=0.73-0.98). The standard error of measurements and minimal detectable changes were rather small in both groups. Conclusion: Ultrasound imaging is a highly reliable method to assess muscle thicknesses and contraction ratio of the transversus abdominis and lumbar multifidus during different conditions, even in patients with CLBP and abnormal lumbar lordosis.

Effect of progressive muscle relaxation as an add-on to pulmonary telerehabilitation in discharged patients with COVID-19: A randomised controlled trial.

BACKGROUND: and purpose: Most patients with coronavirus disease 2019 (COVID-19) experience persistent physical and psychological symptoms. This study aimed to investigate the effects of pulmonary telerehabilitation (PTR) combined with progressive muscle relaxation (PMR) on the physical and psychological outcomes of discharged patients with COVID-19. MATERIALS AND METHODS: This randomised, assessor-blinded, parallel-group study was conducted in hospitals affiliated with Qom University of Medical Sciences between May and October 2021. Discharged COVID-19 patients aged 18-65 years were randomly assigned to two groups of 26 patients each. The experimental group underwent PTR and PMR for six weeks, while the comparison group received PTR alone. Primary (functional capacity) and secondary (dyspnoea, anxiety, depression, fatigue, sleep quality, and quality of life) outcomes were evaluated at baseline and after six weeks. RESULTS: The experimental group showed significantly higher sleep quality (P = 0.001, 95% confidence interval [CI]: 1.20-4.09) and significantly lower fatigue (P = 0.041, 95% CI: 4.79-5.25) and anxiety (P = 0.001, 95% CI: 1.21-4.47) than the comparison group. No between-group differences were observed in terms of other outcomes (P > 0.05). CONCLUSION: PTR coupled with PMR was more effective for promoting sleep quality and alleviating anxiety and fatigue than PTR alone.

SWI/SNF chromatin remodeling subunit Smarca4/BRG1 is essential for female fertility†.

Mammalian folliculogenesis is a complex process that involves the regulation of chromatin structure for gene expression and oocyte meiotic resumption. The SWI/SNF complex is a chromatin remodeler using either Brahma-regulated gene 1 (BRG1) or BRM (encoded by Smarca4 and Smarca2, respectively) as its catalytic subunit. SMARCA4 loss of expression is associated with a rare type of ovarian cancer; however, its function during folliculogenesis remains poorly understood. In this study, we describe the phenotype of BRG1 mutant mice to better understand its role in female fertility. Although no tumor emerged from BRG1 mutant mice, conditional depletion of Brg1 in the granulosa cells (GCs) of Brg1fl/fl;Amhr2-Cre mice caused sterility, whereas conditional depletion of Brg1 in the oocytes of Brg1fl/fl;Gdf9-Cre mice resulted in subfertility. Recovery of cumulus-oocyte complexes after natural mating or superovulation showed no significant difference in the Brg1fl/fl;Amhr2-Cre mutant mice and significantly fewer oocytes in the Brg1fl/fl;Gdf9-Cre mutant mice compared with controls, which may account for the subfertility. Interestingly, the evaluation of oocyte developmental competence by in vitro culture of retrieved two-cell embryos indicated that oocytes originating from the Brg1fl/fl;Amhr2-Cre mice did not reach the blastocyst stage and had higher rates of mitotic defects, including micronuclei. Together, these results indicate that BRG1 plays an important role in female fertility by regulating granulosa and oocyte functions during follicle growth and is needed for the acquisition of oocyte developmental competence.

Perturbation-based Balance Training to improve postural responses and falls in people with multiple sclerosis: a randomized controlled trial.

PURPOSE: To determine the effects of Perturbation-based Balance Training (PBT) on postural responses and falls in people with multiple sclerosis (PwMS) and compare the results with conventional balance training (CBT). MATERIALS AND METHODS: Thirty-four PwMS were randomized to receive 4 weeks of PBT or CBT. Latency of postural responses to external perturbations, Timed-Up-and-Go (TUG), 10-meter-walk (10MW), Berg Balance Scale (BBS), and Activities-specific Balance Confidence Scale (ABC) were measured at baseline and post-training. Also, the proportion of fallers and fall rate were assessed at a 3-month follow-up. RESULTS: The latency of postural responses significantly decreased in PBT compared to CBT. TUG, 10MW, BBS, and ABC, at post-training, and relative risk of falls and fall rate at 3-month follow-up had no statistically significant between-group differences. CONCLUSIONS: The results show that PBT is at least as effective as CBT in improving balance and decreasing falls, while it has superiority over CBT whenever the clinicians mainly aim to improve reactive balance strategies. Future studies with a larger sample size are warranted to complement the results of this study.Implication for rehabilitationPerturbation-based Balance Training is at least as effective as conventional balance training (CBT) in improving proactive postural control in people with multiple sclerosis (PwMS).Perturbation-based Balance Training has superiority over CBT in improving reactive postural control in PwMS.Perturbation-based Balance Training has no superiority over CBT in improving fall-related outcomes.

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

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

Effects of exergaming on cognition, lower limb functional coordination, and stepping time in people with multiple sclerosis: a randomized controlled trial.

PURPOSE: To compare the effects of exergaming versus conventional exercises on cognition, lower-limb functional coordination, and stepping time in people with multiple sclerosis (PwMS). METHODS: Thirty-six PwMS were randomly assigned to either intervention (n = 18) or control (n = 18) group and received 18 training sessions during six weeks. The intervention group performed exergames that required multidirectional timed-stepping, weight-shifting, and walking while the control group performed conventional matched exercises. Trail making test (TMT part A, B; TMT-A, TMT-B, TMT B-A), six-spot step test (SSST), and choice stepping reaction time (CSRT-including reaction time (RT), movement time (MVT), and total response time (TRT)) were assessed pre- and post-intervention (short-term), and after three-month follow-up (mid-term). RESULTS: The intervention group showed faster TMT-B (p = 0.003) and TMT B-A (p = 0.002) at post-intervention and faster SSST at both post-intervention (p = 0.002) and follow-up (p = 0.04). The CSRT components showed no between-group differences at post-intervention; however, at follow-up, the intervention group had lower TRT (p = 0.046) and MVT (p = 0.015). TMT-A and RT had no significant between-group differences. CONCLUSIONS: In short-term, exergames led to more improvements in complex attention, executive function, and lower-limb functional coordination comparing to the matched conventional exercises. In mid-term, exergaming was more effective for improving stepping time and lower-limb functional coordination. However, the two approaches did not show any superiority over each other for improving simple attention and RT.Implications for rehabilitationWhen designed properly, exergames have great potential to improve attention and executive function of people with multiple sclerosis (PwMS), at least in the short-term.Exergames seem like an appropriate option for improving lower limb coordination and decreasing choice stepping response time among PwMS in the mid-term.Exergames do not have superiority in improving the choice stepping reaction time compared to their matched conventional treatment.