The epidemiology of neck and low back pain in Iran: a national and sub-national analysis from 1990 to 2019.

Background: Neck pain (NP) is a condition influenced by multiple factors. It places a significant burden on individuals suffering from NP and on social and economic systems. On a global scale, low back pain (LBP) stands out as a significant contributor to years lost to disability, and this burden is on the rise due to population growth and aging. Methods: The Global Burden of Disease database was used to collect data on the prevalence, incidence, and years lived with disability (YLD) of NP and LBP between 1990 and 2019. Various factors, including age group, gender, Iran, and its 31 provinces, were used to classify the data. Results: Iran accounted for 0.86 million incident cases of NP in 2019, with age-standardized incident rate per 100 000 population of 934.1. Tehran has the maximum age-standardized prevalence, incidence, and YLD. Iran accounted for the age-standardized incidence rate for LBP per 100 000 population of 3492.9, and it reduced to -8.35% from 1990. Mazandaran exhibits the highest levels of prevalence, incidence, and YLD for LBP in 2019. In Iran, the point prevalence of NP in 2019 was higher in females and increased with age up to 50-54 years for females and 70-74 years for males. However, there is only a slight difference between females and males in Iran regarding LBP prevalence. Conclusions: In this study, the authors report the prevalence, incidence, YLD, and age-standardized rates for NP and LBP in the world's general population and Iran's population based on its sub-nations in 1990 and 2019.

Immediate effects of counterforce brace with and without vibration on pain, muscle strength and range of motion in participants with lateral epicondylitis. A pilot study.

Lateral epicondylitis is one of the most common elbow problems. Counterforce braces are commonly used to manage lateral epicondylitis. Recent studies showed that vibration can decrease pain and increase muscle strength by improving motor abilities. The aim of this study was to evaluate the effects of a counterforce brace with and without vibration on pain, muscular strength, wrist and elbow joints range of motion in the participants with lateral epicondylitis. In this repeated measure pre-post clinical trial study, 28 participants with lateral epicondylitis were included. Pain were measured with Visual Analogue Scale (VAS), wrist and elbow flexor/extensor muscles strength with digital dynamometer, wrist and elbow flexion/extension range of motion with goniometer in 3 condition baseline, counterforce brace and counterforce brace with vibration. Pain using counterforce bracing with vibration showed a significant reduction as compared with baseline and counterforce bracing (P < 0.001). Wrist flexor muscles strength (P = 0.005), elbow flexor/extensor muscles strength respectively (P = 0.04, P = 0.02), wrist flexion/extension range of motion (P < 0.001) following the use of counterforce bracing with vibration increased significantly compared with baseline. The results show that the counterforce bracing with and without vibration relieves pain and improves range of motion and muscles strength in lateral epicondylitis participants, but this improvement is more significant with the use of vibration.

Validity and reliability of the Persian version of self-administered foot evaluation questionnaire (SAFE-Q) in people with foot orthopedic problems.

INTRODUCTION: Foot problems are one of the main causes of seeing a doctor. According to the World Health Organization's definition of health, the healthcare system must consider patients' quality of life as an important entity. In this regard, many tools have been developed to evaluate patients' opinions about their health status. The purpose of the present study is to evaluate the validity and reliability of the Persian version of the Foot Self-Assessment Questionnaire (SAFE-Q) in patients with foot orthopedic problems. METHOD: 215 people aged 17-60 years with orthopedic foot problems were included in this cross-sectional study. The Spearman correlation coefficient of SAFE-Q questionnaires versus Foot Function Index (FFI) questionnaire was evaluated for the convergent validity. Forty-three people randomly completed SAFE-Q again one week later. Intraclass correlation coefficient (ICC) and Cronbach's alpha was calculated to evaluate the test-retest reliability and internal consistency of the SAFE-Q, respectively. RESULTS: A strong relationship was found between the SAFE-Q total score and other scales with FFI questionnaire (r = 0.52 to 0.87). ICC test-retest reliability and Cronbach's alpha were 0.981 and 0.98 for SAFE-Q, respectively. CONCLUSION: The results indicate that the Persian version of the SAFE-Q questionnaire has acceptable validity and reliability and can be used to assess the health status and quality of life of Persian speakers with orthopedic foot problems.

Identification of potentially functional modules and diagnostic genes related to amyotrophic lateral sclerosis based on the WGCNA and LASSO algorithms.

Amyotrophic lateral sclerosis (ALS) is a genetically and phenotypically heterogeneous disease results in the loss of motor neurons. Mounting information points to involvement of other systems including cognitive impairment. However, neither the valid biomarker for diagnosis nor effective therapeutic intervention is available for ALS. The present study is aimed at identifying potentially genetic biomarker that improves the diagnosis and treatment of ALS patients based on the data of the Gene Expression Omnibus. We retrieved datasets and conducted a weighted gene co-expression network analysis (WGCNA) to identify ALS-related co-expression genes. Functional enrichment analysis was performed to determine the features and pathways of the main modules. We then constructed an ALS-related model using the least absolute shrinkage and selection operator (LASSO) regression analysis and verified the model by the receiver operating characteristic (ROC) curve. Besides we screened the non-preserved gene modules in FTD and ALS-mimic disorders to distinct ALS-related genes from disorders with overlapping genes and features. Altogether, 4198 common genes between datasets with the most variation were analyzed and 16 distinct modules were identified through WGCNA. Blue module had the most correlation with ALS and functionally enriched in pathways of neurodegeneration-multiple diseases', 'amyotrophic lateral sclerosis', and 'endocytosis' KEGG terms. Further, some of other modules related to ALS were enriched in 'autophagy' and 'amyotrophic lateral sclerosis'. The 30 top of hub genes were recruited to a LASSO regression model and 5 genes (BCLAF1, GNA13, ARL6IP5, ARGLU1, and YPEL5) were identified as potentially diagnostic ALS biomarkers with validating of the ROC curve and AUC value.

The effects of orthotics device on the balance control in multiple sclerosis patients: A systematic review and meta-analysis.

BACKGROUND: Multiple sclerosis refers to a progressive autoimmune inflammatory disease in the central nervous system usually accompanied by balance disorder. Our systematic review aimed to investigate the effects of orthotic devices on balance control of multiple sclerosis patients. METHODS: The search procedure was according to the population, intervention, comparison, and outcome (PICO) strategy. We looked into PubMed, Embase, ISI Web of Knowledge, and Scopus databases and included all studies published since 1980. Two researchers did the searches separately and evaluated the selected papers' quality based on the physiotherapy evidence database (PEDro) scale and Cochrane risk of bias tool. We did a meta-analysis to evaluate the interventions' effects on the balance factors. RESULTS: We found nine studies, of which seven studies with 162 participants were included in our meta-analysis. Four studies investigated the effect of foot orthoses, one evaluated the effect of shoe modifications and four evaluated the effect of ankle foot orthoses. There was no significant immediate difference between the insole and control groups in center of pressure velocity change, C7 displacement, in both open and closed eyes conditions. Also, there was no significant immediate difference between ankle foot orthosis' intervention and control groups in center of pressure velocity and displacement changes in antero-posterior and medio-lateral directions, in both open and closed eyes conditions. We could not do a meta-analysis for shoe modification. CONCLUSION: Few studies have assessed the effects of orthoses on balance control in multiple sclerosis patients. Studies on ankle foot and foot orthoses show inconsistent results. According to our meta-analysis, orthotic interventions do not seem to improve the balance of people with multiple sclerosis.

The effect of pre-fabricated insole on plantar pressure distribution in patients with rheumatoid arthritis.

BACKGROUND: Foot deformities result in pain and changes in plantar pressure distribution in rheumatoid arthritis (RA) patients. Medical insoles are commonly prescribed for declining pain and modifying foot pressure distribution in these patients. The purpose of this study was to evaluate the effect of a pre-fabricated insole with metatarsal pad and medial longitudinal arch support on plantar pressure distribution in rheumatoid arthritis patients. METHODS: Fifteen females with RA participated in this study. All patients received a pair of pre-fabricated insoles that were individually modified using metatarsal pads and medial longitudinal arch supports. Mean peak pressure (kPa), maximum force (N), and contact area (cm2) were calculated for the heel, midfoot, metatarsophalangeal joint, and toe regions using the Pedar-X system immediately and after a month follow-up. FINDINGS: In the heel and metatarsophalangeal joint regions, maximum pressure and force showed a significant reduction in the follow-up assessment (p < 0.05). The comparison showed a significant increase in maximum pressure and force in the midfoot when participants walked with insole compared to without insole condition (p < 0.001). INTERPRETATION: Using a pre-fabricated insole with an individually modified metatarsal pad and medial longitudinal arch support could alter rheumatoid arthritis patients' plantar pressures after one month of follow-up. This type of insole is simple and inexpensive and showed a significant effect on decreasing pressures under the metatarsal heads.

Effects of vibro-medical insoles with and without vibrations on balance control in diabetic patients with mild-to-moderate peripheral neuropathy.

The purpose of this study was to investigate the effects of a total-contact insole with and without subthreshold mechanical random noise on the balance control in diabetic patients with mild-to-moderate peripheral neuropathy. Twenty diabetic patients with mild-to-moderate neuropathy was recruited to this study. A total-contact insole was prototyped and vibratory motors were embedded into it. The parameters of the center of pressure (amplitude, velocity, and phase plane portrait) were analyzed after 30-minute walks with the shoe only, the shoe with vibro-medical insole with and without vibrations in eyes open and closed condition. The center of pressure amplitude, velocity, and phase plane portrait in the anterior-posterior and medio-lateral directions were significantly decreased using a vibro-medical insole without vibration in the eyes open condition (p < 0.05), as compared to the shoe, and with vibro- medical insole with vibration in both eyes open and closed conditions (p < 0.05) compared to the shoe. A significant drop was observed in the center of pressure amplitude, velocity and phase plane portrait parameters when the vibro-medical insole with vibration was used compared to vibro- medical insole without vibration in eyes closed condition (p < 0.05). The use of vibro-medical insoles was found to improve the patient's balance control, as compared to the shoe. In the eyes closed condition, an improvement in the balance control was observed only with vibro-medical insole with vibration rather than vibro-medical insole without vibration or the shoe. Current finding suggest that a combination of the total-contact insole with vibration may improve the balance control remarkably in diabetic patients with mild-to-moderate neuropathy.

A systematic review on the validity and reliability of tape measurement method in leg length discrepancy.

Background: Leg length discrepancy measurement is an essential part of musculoskeletal clinical assessment, and tape measurement is a common clinical method. This study aimed to systematically review the results of the findings of studies on validity and reliability of the tape measurement method and the quality of reporting the literature on this topic. Methods: A search was performed in PubMed, EBSCO, Science Direct, Web of Knowledge, Scopus, Embase, and Google Scholar using selected keywords from inception to December 2017.This systematic review was based on the PRISMA guideline. After a systematic selection process, the quality of the included studies was assessed independently by 2 reviewers using the Brink and Louw Scale for quality assessment. Results: A total of 11 studies were finally considered for this systematic review. Two studies were about the validity of (a measurement tool) studies and 4 were reliability analysis only. Validity and reliability analyses were simultaneously applied to 5 studies. Also, 9 out of 11 studies were deemed to be of high quality based on Brink and Louw Scale. Studies showed high (ICC=0.7) to very high (ICC=0.9) levels of interrater and intrarater reliability. The validity of the methods ranged from low to very high depending on subjects. Conclusion: Tape measurement method has acceptable reliability and validity in healthy people, but it does not have acceptable validity in measuring obese people and patients with musculoskeletal disorders. Thus, using a suitable method for LLD leg length discrepancy measurement seems to be necessary for obese and individuals with leg length discrepancy.

The effects of vibro-medical insole on sensation and plantar pressure distribution in diabetic patients with mild-to-moderate peripheral neuropathy.

BACKGROUND: The first aim of this study was to determine the effect of a vibro-medical insole on pressure sensation and the second was to measure the effects of a vibro-medical insole with and without random noise on plantar pressure distribution in diabetic patients with mild-to-moderate peripheral neuropathy. METHODS: Twenty patients with mild-to-moderate diabetic neuropathy were recruited in the clinical trial pre-test, post-test study. A medical insole was made for each participant and a vibratory system was inserted into it. Pressure sensation was evaluated before and after the 30-min walk using the vibro-medical insole with added random noise by Semmes-Weinstein Monofilaments. Peak pressure data was measured before and after 30-min walking with a vibro-medical insole with and without random noise by the Pedar-x system. FINDINGS: Pressure sensations showed improvement after 30-min walking with the vibro-medical insole with added random noise at the heel, metatarsophalangeal heads and hallux of both feet in all participants (p < 0.05). Peak pressure decreased significantly in the heel, MTP2,3, MTP4,5 and hallux (p < 0.05) and increased in midfoot (p < 0.05) using the vibro-medical insole with and without random noise compared to the shoe only condition. Only the peak pressure of the heel region decreased using the vibro-medical insole with random noise compared to without random noise (p = 0.006). INTERPRETATION: Thirty minute walking with a vibro-medical insole seems to improve pressure sensation and alter peak pressure in diabetic patients with mild-to-moderate peripheral neuropathy. This work suggests that vibro-medical insoles can be used for daily living activities and possibly decreases the risk of ulceration in diabetic neuropathy patients.

The effects of Vibro-medical insole on vibrotactile sensation in diabetic patients with mild-to-moderate peripheral neuropathy.

Peripheral sensory neuropathy seems to be the main risk factor for diabetic foot ulceration. Previous studies demonstrated that stochastic resonance can improve the vibrotactile sensation of diabetic patients. The aim of this study was to evaluate the effects of Vibro-medical insole on pressure and vibration sensation in diabetic patients with mild-to-moderate peripheral neuropathy. A total of 20 patients with mild-to-moderate diabetic neuropathy were included in the pre-test and post-test clinical trial study. Vibro-medical insole consists of medical insole and vibratory system. Medical insole was made independently for each participant and vibratory system was inserted in it. Pressure and vibration sensation were evaluated before and after 30-min walking with Vibro-medical insole. Semmes-Weinstein monofilaments and tuning fork were used to evaluate pressure and vibration sensation, respectively. Pressure sensation showed significantly improvement using Vibro-medical insole at the heel, first and fifth metatarsophalangeal heads, and hallux of both feet in all participants (p < 0.001). Vibration sensation also improved at the big toe of both feet with 256 Hz tuning fork (p < 0.05) but no statistically significant effect was found with 128 Hz tuning fork (p > 0.05). Vibro-medical insole significantly improved pressure and vibration sensation of the foot in diabetic patients with mild-to-moderate peripheral neuropathy. The results suggest that Vibro-medical insole can be used for daily living activities to overcome sensory loss in diabetic neuropathy patients.

The clinical and biomechanical effects of subthreshold random noise on the plantar surface of the foot in diabetic patients and elder people: A systematic review.

BACKGROUND: Central nervous system receives information from foot mechanoreceptors in order to control balance and perform movement tasks. Subthreshold random noise seems to improve sensitivity of the cutaneous mechanoreceptor. OBJECTIVES: The purpose of this study was to systematically review published evidence conducted to evaluate the clinical and biomechanical effects of subthreshold random noise on the plantar surface of the foot in diabetic patients and elder people. STUDY DESIGN: Systematic review. METHODS: A literature search was performed in PubMed, Scopus, ScienceDirect, Web of Knowledge, CINAHL, and EMBASE databases based on population, intervention, comparison, outcomes, and study method. Quality of studies was assessed using the methodological quality assessment tool, using Physiotherapy Evidence Database scale. RESULTS: In all, 11 studies were selected for final evaluation based on inclusion criteria. Five studies evaluated the effects of subthreshold random noise in diabetic patients and six in elder people. In seven studies, biomechanical (balance and gait parameters) effects and in four studies clinical (pressure and vibration sensations) effects of subthreshold random noise were investigated. All reviewed studies were scored fair (2) to good (9) quality in terms of methodological quality assessment using Physiotherapy Evidence Database scale. CONCLUSION: The results indicated that subthreshold random noise improves balance and sensation in diabetic patients and elder people. Also gait variables can be improved in elder people with subthreshold random noise. However, further well-designed studies are needed. CLINICAL RELEVANCE: The previous studies reported that subthreshold random noise may improve gait, balance, and sensation, but more studies are needed to evaluate the long-term effect of subthreshold random noise in shoe or insole for daily living tasks in diabetic patients and elder people.

Effect of rocker shoes on pain, disability and activity limitation in patients with rheumatoid arthritis.

BACKGROUND: Rheumatoid arthritis is a chronic inflammatory joint disease which affects the joints and soft tissues of the foot and ankle. Rocker shoes may be prescribed for the symptomatic foot in rheumatoid arthritis; however, there is a limited evidence base to support the use of rocker shoes in these patients. OBJECTIVES: The aim of this study was to evaluate the effectiveness of heel-to-toe rocker shoes on pain, disability, and activity limitation in patients with rheumatoid arthritis. STUDY DESIGN: Clinical trial. METHODS: Seventeen female patients with rheumatoid arthritis of 1 year or more duration, disease activity score of less than 2.6, and foot and ankle pain were recruited. Heel-to-toe rocker shoe was made according to each patient's foot size. All the patients were evaluated immediately, 7 and 30 days after their first visit. Foot Function Index values were recorded at each appointment. RESULTS: With the use of rocker shoes, Foot Function Index values decreased in all subscales. This reduction was noted in the first visit and was maintained throughout the trials. CONCLUSION: Rocker shoe can improve pain, disability, and activity limitation in patients with rheumatoid foot pain. All the subjects reported improved comfort levels. CLINICAL RELEVANCE: The results of this study showed that high-top, heel-to-toe rocker shoe with wide toe box was effective at reducing foot and ankle pain. It was also regarded as comfortable and acceptable footwear by the patients with rheumatoid foot problems.