Translation, cross-cultural adaptation, and psychometric properties of the Arabic version of the MedRisk instrument for measuring patient satisfaction with physical therapy care.

PURPOSE: This study aimed to translate, cross-culturally adapt, and validate the MedRisk Instrument for Measuring Patient Satisfaction with Physical Therapy Care into Arabic (MRPS-Ar). MATERIALS AND METHODS: The 20-Item MRPS was translated and cross-culturally adapted into Arabic following international guidelines. Patients (n = 229) with musculoskeletal conditions who received physical therapy care completed the MRPS-Ar and global rating of change scale. Of these patients, 95 completed the MRPS-Ar twice. Factor structure, floor and ceiling effects, internal consistency, test-retest reliability, and construct validity of the MRPS-Ar were evaluated. RESULTS: Principal component analysis suggested 3-factor solution: a 7-item facility experience, 6-item therapeutic experience, and 3-item positive experience. The MRPS-Ar and its factors showed acceptable internal consistency (Cronbach's alpha coefficients ranged from 0.819 to 0.936) and excellent test-retest reliability (ICCs ranged from 0.965 to 0.983). The global measures of satisfaction were significantly correlated with the global rating of change (Spearman's rho = -0.678, p < 0.001 for item "overall satisfaction" and Spearman's rho = -0.690, p < 0.001 for item "would return"). CONCLUSIONS: The 18-item MRPS-Ar displayed adequate psychometric properties for measuring patients' satisfaction with physical therapy care. The MRPS-Ar is a reliable and valid instrument that can be used in medical, clinical, and research fields.

Current views on preoperative rehabilitation practice after anterior cruciate ligament injury among licensed physical therapists in Saudi Arabia: An online-based cross-sectional survey.

Preoperative rehabilitation is an important stage to both physically and mentally prepare patients for anterior cruciate ligament reconstruction (ACLR) and postoperative rehabilitation. This study aimed to investigate the current preoperative rehabilitation practice after anterior cruciate ligament injury among licensed physical therapists in Saudi Arabia. This was an online-based cross-sectional survey. A total of 114 physical therapists completed the survey. The survey consisted of 16 mandatory questions about management strategies, prescribed exercises, patients' physical and psychological concerns, and discussions about nonoperative management. The majority of the respondents used the following preoperative interventions: education (89.5%), closed kinetic chain exercises (66.7%), stretches (63.2%), open kinetic chain exercises (61.4%), proprioceptive exercises (59.6%), cold (56.1%), and activity modification advice (52.6%). More than half of the respondents would recommend patients awaiting ACLR to complete the exercises 2 to 4 times weekly (56.1%) for up to 8 weeks (80.7%) before ACLR. The respondents (73.7%) reported that patients awaiting ACLR did not receive preoperative rehabilitation due to 2 primary factors: the orthopedic team did not refer patients to rehabilitation specialists, and there was a lack of awareness about preoperative rehabilitation. Most therapists (86%) would discuss conservative management if a patient returned to their preinjury level of function before surgery. The surveyed physical therapists reported using various interventions and preoperative rehabilitation lengths with patients awaiting ACLR. The majority of the therapists indicated that patients awaiting ACLR did not receive preoperative rehabilitation. Future studies are needed to establish a consensus on the optimal preoperative rehabilitation program.

Ipsilateral versus contralateral static endurance- balance abilities among healthy college students.

Objectives: This study sought to determine the association and the difference, if any, between the levels of the contralateral and between the levels of the ipsilateral sides during static endurance-balance exercise. Methods: One hundred twelve healthy active- college students (55 females and 57 males) participated in this cross-sectional study. Each participant performed the contralateral (raising one arm and opposite-side leg) quadruped bird dog exercise and balanced in static condition. Side bridge exercise was performed from lying on your side then engaging your core muscles and lifting your upper body and hips off the ground, maintaining a straight line and holding this position as long as tolerated. Results: Wilcoxon signed rank test showed significant difference (p = 0.004) between the contralateral right and left quadruped bird dog but insignificant difference (p = 0.059) between the ipsilateral right and left side bridge endurance-balance exercises. Mann-Whitney U test showed that the holding time was significant across gender for the contralateral but was insignificant for the ipsilateral endurance-balance exercise. Mann-Whitney U test was insignificant (p > 0.05) between those being recreationally active or inactive. Kruskal-Wallis test revealed insignificant difference between body mass index categories. Spearman's rho correlation coefficient showed strong positive correlation equals 0.85 and 0.75 (p < 0.001) of the contralateral quadruped bird dog and the ipsilateral side bridge exercises respectively. Conclusions: A significant difference was observed for contralateral, while no significant difference was found for ipsilateral endurance-balance abilities. Therefore, clinicians and rehab specialist should consider these findings when assessing the endurance-balance abilities to properly devise appropriate exercise progression of different trunk stabilizers.

Current Rehabilitation Practices and Return to Sports Criteria After Anterior Cruciate Ligament Reconstruction: A Survey of Physical Therapists in Saudi Arabia.

CONTEXT: With the high prevalence of anterior cruciate ligament rupture among young and active individuals, rehabilitation after the injury and surgery should meet the current evidence-based recommendations to restore knee function and reduce the risk of further injury. This study aimed to investigate the current rehabilitation practices and return to sports (RTS) criteria after anterior cruciate ligament reconstruction (ACLR) among physical therapists in Saudi Arabia. DESIGN: Online cross-sectional survey-based study. METHODS: A total of 177 physical therapists in Saudi Arabia participated in this survey. The survey included questions about the preferred postoperative timing and frequency of rehabilitation, current views on the importance of preoperative and postoperative rehabilitation to the overall outcomes, the timeframe of RTS, and the decision-making process to RTS. RESULTS: Most therapists (96.6%) believed preoperative rehabilitation was essential/important to postoperative outcomes. Two-thirds encouraged patients to start rehabilitation program within 1 to 4 days immediately post-ACLR. RTS was permitted 6 to 9 months post-ACLR by 60% of therapists if satisfied with patient progress and capacity. Factors considered before RTS included knee strength (72.9%), functional capacity (86.4%), lower limb and trunk mechanics (62.7%), and psychological readiness (42.2%). Knee strength was assessed by manual muscle testing (39%), handheld dynamometry (15.3%), and isokinetic dynamometer (13.6%). While 60% of the therapists used single-limbed hop for distance for evaluating functional capacity, only 27.1% used a hop test battery. CONCLUSIONS: The surveyed physical therapists in Saudi Arabia demonstrated variations in the current rehabilitation practices and RTS criteria post-ACLR. Over half of the surveyed therapists considered preoperative rehabilitation essential to postoperative outcomes. However, the therapists should update their perspective with current evidence-based practice regarding the RTS timeframe, psychological readiness assessment for RTS, and knee strength evaluation using objective measurements.

Self-Reported Moderate-to-Vigorous Physical Activity: Its Association with Health-Related Quality of Life in a Large Cohort of People with Chronic Diseases.

The aim of this study was to investigate the dose-response relationship between physical activity and health-related quality of life (HRQoL) in a large population-based sample of people with chronic disease. We analysed the data of 29,271 adults (15,315 women) who were diagnosed with chronic diseases and participated in the Welsh Health Survey (Wales, UK; data collection 2011-2015). Participants were classified, based on their weekly minutes of moderate-to-vigorous physical activity (MVPA), into four groups as follows: inactive (no MVPA), insufficiently active (<150 min/week), sufficiently active (≥150-<300), and very active (≥300). The main outcome was HRQoL measured via the Short-Form 36 Health Survey (SF-36). This study found a curvilinear association between MVPA and HRQoL and a dose-response relationship for the perception of general health and vitality domains. Compared to inactive participants, those who were very active had higher HRQoL scores (coefficient = 12.54; 95% confidence interval [CI] 11.39-13.70), followed by sufficiently active (coefficient = 11.70; 95% CI 10.91-12.49) and insufficiently active (coefficient = 9.83; 95% CI 9.15-10.51) participants. The fully adjusted regression model showed curvilinear associations between MVPA and the domains of SF-36. Future research should find ways to motivate people with chronic diseases to engage in physical activity. The evidence to support regular exercise in individuals with chronic diseases in all age groups is strong and compelling, and patients should be encouraged to regularly devote more time to physical activity in order to improve their health and well-being.

Prevalence of lower back pain and its associations with lifestyle behaviors among college students in Saudi Arabia.

BACKGROUND: Lower back pain (LBP) is a common musculoskeletal disorder that may affect students' daily lives. Recent psychological research showed a relevant connection between LBP and multidimensional health. However, the association between LBP and lifestyle behavior has not been established, and improving knowledge in this area may help develop preventive strategies and optimize college students' quality of life. METHODS: A cross-sectional study of 1420 college students in Saudi Arabia was conducted, and participants who attended Saudi Universities were recruited from May 2021 to November 2021. An established validated online survey assessed LBP, sleep quality, time spent sedentary (sedentary duration), health responsibility, physical activity, nutrition, spiritual growth, interpersonal relationships, and stress management. Generalized Linear Regression was used to assess the associations between LBP severity and lifestyle behaviors after controlling for covariates. RESULTS: LBP was prevalent among college students from Saudi Arabia. Most of the sample were young (23.81 ± 6.02), and female (83.7%). There were significant differences between students with and without LBP regarding age, BMI, sex, marital status, pain severity, overall lifestyle behavior, health responsibility, physical activity, nutrition, stress management, and global sleep quality. After controlling for age, BMI, sex, and marital status, there were significant associations between pain severity and global sleep quality (ß=0.2, p < .001, CI: 16 to 0.24), and sedentary duration (ß=0.03, p = .01, CI:0.009 to 0.06). CONCLUSIONS: This study helped define the prevalence of LBP in college students in Saudi Arabia and evaluated the association between LBP and lifestyle behaviors. The findings showed that students with higher levels of poor sleep quality or sedentary behavior had higher levels of pain. Promoting sleep quality and reducing sedentary behavior may help establish preventive strategies for LBP in college students.

Translation and Validation of the Arabic Version of the Athlete Sleep Screening Questionnaire.

Sleep improves the cognitive and physical performance of athletes. A detailed questionnaire that detects sleep disruptions is required to identify sleep-deprived athletes. This study evaluates the translated Athlete Sleep Screening Questionnaire (ASSQ), a tool suggested by the International Olympic Committee, among Arabic-speaking athletes. The ASSQ was translated into Arabic and examined for floor or ceiling effects, internal consistency, and validity among Arabic-speaking athletes. The Arabic Pittsburgh Sleep Quality Index (PSQI) was employed to assess convergent validity. Ninety athletes (28.9% women) participated and completed this study's questionnaires. The Cronbach's alpha for the ASSQ-Sleep Difficulty Score (SDS) was 0.435, and that of the ASSQ-chronotype was 0.632. The SDS and chronotype subset of the ASSQ demonstrated excellent test-retest reliability, with intraclass correlation coefficients of 0.84 and 0.938, respectively. The ASSQ-SDS correlated positively with the PSQI (0.734, p = 0.001). The ASSQ-chronotype was inversely associated with the PSQI (p = 0.001). This study's findings can assist clinicians in assessing sleep disorders in sports. The Arabic version of the ASSQ has satisfactory psychometric qualities and can identify clinically relevant sleep problems in athletes.

The association between sedentary behavior and low back pain in adults: a systematic review and meta-analysis of longitudinal studies.

Background: Low back pain (LBP) is a common musculoskeletal problem globally. While spending a longer time in sedentary behaviors is linked to several health problems; the quantitative association between different amounts of sedentary time and LBP is still unknown. This study aims to systematically review studies that examined the association between sedentary behavior and LBP development and LBP-related outcomes. Methods: This systematic review and meta-analysis retrieved journal articles published from inception to March 2020 and were obtained by searching bibliographical databases. We included longitudinal study designs, including adult (aged ≥18) individuals with nonspecific LBP, and reporting estimates of the association between sedentary behavior and LBP development and LBP-related outcomes (i.e., pain intensity and disability). Results: Sixteen longitudinal studies with 100,002 participants were included in this review (eight studies included in quantitative syntheses with 83,111 participants). The results of meta-analyses showed that a sedentary time of 3-<6 (Odds ratio (OR) 0.95, 95% CI [0.85-1.07]), 6-8 (OR 0.95, 95% CI [0.88-1.02]), and >8 (OR 0.92, 95% CI [0.85-1.00]) hours per day (h/d) was not associated with LBP development. A sedentary time of ≥3 h/d was associated with poor LBP-related disability (OR 1.24, 95% CI [1.02-1.51]), but not with pain intensity. Conclusion: A meta-analyses of longitudinal studies indicated that sedentary behavior of different durations was not associated with LBP development. However, the results showed that sedentary behavior ≥3 h/d was associated with worse LBP-related disability. These conclusions are tentative as the evidence was derived from mostly fair-quality studies using subjective measures of sedentary behavior. Systematic review registration: PROSPERO (registration number CRD42018107078).

The Arabic Version of the Tegner Activity Scale in Patients with Anterior Cruciate Ligament Reconstruction: Translation, Validation, and Cross-Cultural Adaptation.

BACKGROUND: The Tegner activity scale is a patient-reported questionnaire that is frequently used to measure activity levels in patients with anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to translate, cross-culturally adapt, and validate the Tegner activity scale into Arabic. METHODS: The Tegner activity scale-Arabic version (TAS-Ar) was forward and backward translated, cross-culturally adapted, and validated according to established guidelines. Seventy-five patients who underwent ACLR were instructed to complete the TAS-Ar, the International Knee Documentation Committee (IKDC) subjective knee evaluation form, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) scale. The test-retest reliability of the TAS-Ar was assessed in 39 patients. Statistical tests were conducted to test the reliability and construct validity of the TAS-Ar. RESULTS: The TAS-Ar showed excellent test-retest reliability, with intraclass correlation coefficients of 0.836 (p < 0.001). The TAS-Ar was significantly correlated with the IKDC (Spearman's rho = 0.476, p < 0.001), all KOOS subscales (Spearman's rho = 0.195-0.497, p < 0.05), and the KOOS total score (Spearman's rho = 0.469, p < 0.001). CONCLUSIONS: The Arabic version of the Tegner activity scale is a reliable and valid measure that can be used to evaluate the activity level of Arabic-speaking patients following ACLR.

Knowledge, Attitude, and Practice among Physical Therapists toward COVID-19 in the Kingdom of Saudi Arabia-A Cross-Sectional Study.

To curb the COVID-19 pandemic, the knowledge, attitude, and practice (KAP) of preventive measures play an essential role, and healthcare workers have had to endure a burden to care for COVID-19 patients. Thus, this study aimed to assess the weight of the KAP of physiotherapists in Saudi Arabia during the COVID-19 pandemic. This was a cross-sectional study, where we circulated an online KAP questionnaire to 1179 physical therapists, and among those, 287 participated and completed the questionnaire. The collected responses were analyzed using descriptive statistics, t-test, ANOVA, correlation, and regression analyses, and p-value ≤ 0.05 was considered statistically significant. Both males and females participated in almost equal numbers; most of the participants were <40 years, had a bachelor's level of education, and were from the central region of Saudi Arabia. Social media and the internet were the primary sources of COVID-19-related information (74.6%). Knowledge components A (92%) and B (73.9%) were excellent among most participants. Approximately half of the participants (50.5%) had a moderate attitude toward COVID-19, and regarding the practice component, most participants (74.6%) scored moderately. Correlation analysis showed a low positive relationship between knowledge A, attitude, and practice components. Still, there was a very low positive relationship between knowledge B, attitude, and practice components, but both were statistically significant. Our study showed that physical therapists in Saudi Arabia exhibit good knowledge, attitude, and practice toward COVID-19.

Arabic Version of the Short Anterior Cruciate Ligament-Return to Sport After Injury Scale: Translation, Cross-cultural Adaptation, and Validation.

BACKGROUND: The short version of the Anterior Cruciate Ligament-Return to Sport After Injury (ACL-RSI) scale is a self-reported questionnaire developed to assess the psychological readiness of patients to return to sports after ACL reconstruction (ACLR). PURPOSE: To translate, cross-culturally adapt, and validate the short version of the ACL-RSI scale into the Arabic language (ACL-RSI-Ar). STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: The original short version of the ACL-RSI scale was forward and backward translated, cross-culturally adapted, and validated following international standardized guidelines. Sixty patients who participated in sports activities and underwent ACLR completed the ACL-RSI-Ar, the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, and Knee injury and Osteoarthritis Outcome Score (KOOS) scales. To assess test-retest reliability, 34 participants completed the ACL-RSI-Ar scale twice. Statistical tests were conducted to test the internal consistency, reliability, and construct and discriminant validity of the ACL-RSI-Ar scale. RESULTS: The ACL-RSI-Ar showed adequate internal consistency (Cronbach alpha = 0.734) and excellent test-retest reliability (intraclass correlation coefficient, 0.871). The ACL-RSI-Ar was strongly correlated with the IKDC (Spearman ρ = 0.515, P < .001) and weakly to strongly correlated with all KOOS subscales (Spearman ρ = 0.247-0.590, P < .05). Patients who returned to sports had significantly higher scores on the ACL-RSI-Ar scale when compared with those who did not return to sports (P = .001). CONCLUSION: The short ACL-RSI-Ar scale, as translated, was internally consistent, reliable, and valid for evaluating psychological readiness to return to sports after ACLR in Arabic-speaking patients.

Inertial sensors identified asymmetries in shank angular velocity at different gait speeds in individuals with anterior cruciate ligament reconstruction.

BACKGROUND: Inertial sensors can detect between-limb asymmetries in shank angular velocity (SAV) during loading response of walking in individuals with ACL reconstruction (ACLR), which may be indicative of abnormal knee joint loading. However, it is unknown whether these SAV asymmetries would exist up to 6 months post-ACLR and how they differ from SAV asymmetries in uninjured healthy subjects. RESEARCH QUESTION: To investigate whether patients with ACLR show significant and meaningful between-limb SAV asymmetries during walking and walking fast at 4 and 6 months post-surgery and to determine whether limb asymmetries are related across gait tasks and time. METHODS: Fifteen individuals with ACLR participated in this prospective study. Testing occurred in clinical settings. Participants were instructed to walk and walk fast while wearing one inertial sensor on each shank. The average of sagittal plane SAV peaks during loading response of gait was calculated bilaterally. The smallest meaningful between-limb difference for SAV was calculated from uninjured healthy subjects (n = 16) to define the limit of meaningful SAV asymmetries in patients with ACLR. RESULTS: At 4 and 6 months post-ACLR, the involved limb had significantly smaller peak SAV during walking (P < .01, d = 0.69-0.85) and walking fast (P < .005, d = 1.03-1.07) compared to the uninvolved limb. A significant main effect of gait task on SAV asymmetries was found (P = .006, ηp2 = 0.451). Further, patients with ACLR exhibited meaningful SAV asymmetries at both time points for both gait speeds. Limb SAV asymmetries correlated between gait tasks and across time (r = 0.760-0.860, P < .001). SIGNIFICANCE: Individuals with ACLR presented with significant and meaningful SAV asymmetries during walking and walking fast at 4 and 6 months post-surgery. Greater limb SAV asymmetries persisted across gait tasks and time, with greater asymmetry was observed at a faster walking speed. Thus, inertial sensors are feasible to be used in clinical settings to identify SAV asymmetry during gait post-ACLR.