Quantitative Electroencephalography and Balance Test Correlations in Patients with Chronic Patellofemoral Pain.

Background: Quantitative Electroencephalography (QEEG) is a tool helping better understand the electrical activity of the brain and a non-invasive method to assess cortical activity. To date, the brain activity of patients with chronic patellofemoral pain (PFP) has not been investigated. Objective: The current study aimed to investigate the effect of PFP on higher levels of the central nervous system by assessing the correlation between QEEG and modified excursion balance test (mSEBT) in patients with PFP. Material and Methods: Twenty-two patients with chronic PFP participated in this observational study. Their cortical electrical activity was recorded in a resting state with their eyes open, via a 32-channel QEEG. C3, C4, and Cz were considered as regions of interest. In addition to QEEG, the balance performance of the participants was evaluated via mSEBT. Results: The obtained findings revealed a negative and moderate to high correlation between theta absolute power and posteromedial direction of mSEBT in C4 (P 0.000, r -0.68), Cz (P 0.001, r -0.66), and C3 (P 0.000, r -0.70). Additionally, a significantly close correlation is between alpha absolute power in C3 (P 0.001, r -0.70), C4 (P 0.000, r -0.71), and Cz (P 0.000, r -0.74) and the posteromedial direction of mSEBT. No significant correlations were between the other two directions of mSEBT, alpha, and theta. Conclusion: According to our results, balance impairment in patients with chronic PFP correlated with their QEEG neurodynamics. Moreover, our findings demonstrated the efficiency of QEEG as a neuromodulation method for patients with PFP.

The effects of virtual reality training on clinical indices and brain mapping of women with patellofemoral pain: a randomized clinical trial.

BACKGROUND: Virtual reality training (VRT) is a new method for the rehabilitation of musculoskeletal impairments. However, the clinical and central effects of VRT have not been investigated in patients with patellofemoral pain (PFP). To comprehensively assess the effects of VRT on clinical indices and brain function, we used a randomized clinical trial based on clinical and brain mapping assessment. METHODS: Twenty-six women with PFP for more than 6 months were randomly allocated to 2 groups: intervention and control. The intervention consisted of lifestyle education + 8 weeks VRT, in 24 sessions each lasting 40 min of training, whereas the control group just received lifestyle education. The balance was the primary outcome and was measured by the modified star excursion balance test. Secondary outcomes included pain, function, quality of life, and brain function which were assessed by visual analogue scale, step down test and Kujala questionnaire, SF-36, and EEG, respectively. Pre-intervention, post-intervention and follow-up (1 month after the end of the intervention) measurements were taken for all outcome measures except EEG, which was evaluated only at pre-intervention and post-intervention). Analyses of variance was used to compare the clinical outcomes between the two groups. The independent t-test also was used for between group EEG analyses. RESULTS: Balance score (P < 0.001), function (P < 0.001), and quality of life (P = 0.001) improved significantly at post-intervention and 1 month follow-up in the VRT group compared with the control group. VRT group showed a significantly decreased pain score (P = 0.004). Alpha (P < 0.05) and theta (P = 0.01) power activity also increased in the brain of the VRT group. CONCLUSION: This study demonstrated that long term VRT was capable of improving both clinical impairments and brain function in patients with PFP. Therefore, therapists and clinicians can use this method as a more holistic approach in the rehabilitation of PFP. TRIAL REGISTRATION: IRCT, IRCT20090831002391N40 . Registered 23 / 10 / 2019.

Effects of whole body vibration with exercise therapy versus exercise therapy alone on flexibility, vertical jump height, agility and pain in athletes with patellofemoral pain: a randomized clinical trial.

BACKGROUND: Patellofemoral pain (PFP) is the most prevalent orthopedic problem in active young adults. Due to its multifactorial etiology, a variety of therapeutic measures have been adopted to treat PFP, including exercise therapy, electrotherapy, and manual therapy. It has also been suggested that whole body vibration (WBV) can improve neuromuscular function in persons with knee problems. The aim of the present study was to evaluate the effects of adding WBV to routine exercise programs on flexibility, vertical jump height, agility and pain in athletes with PFP. METHODS: Twenty-four male athletes with PFP were randomized into two groups of WBV + exercise (n = 12) or exercise only (n = 12). Participants received their interventions during 4 consecutive weeks (12 sessions). Pain intensity, flexibility and agility were assessed respectively as score on a numerical rating scale, the sit-and-reach test, and a modified T-test, and vertical jump height was measured to the nearest centimeter. The tests were done before and after the interventions, and the results were compared between the two groups. Independent t-tests and paired t-tests were used for between- and within-group comparisons, respectively. RESULTS: After the interventions, all variables for vertical jump height, flexibility, agility and pain intensity improved significantly in both groups (p < 0.05). The flexibility test showed significantly greater improvement in the WBV + exercise group (p<0.001), whereas for vertical jump height, agility and pain intensity, there were no statistically significant differences between groups (p>0.05). CONCLUSIONS: The present findings showed that exercise therapy with and without WBV can significantly decrease pain and increase agility, vertical jump height and flexibility in athletes with PFP. Adding WBV to routine exercise therapy, however, can augment the effects of the latter on flexibility. TRIAL REGISTRATION: IRCT, IRCT20090831002391N39. Registered 7 February 2018, https://en.irct.ir/search/result?query=IRCT20090831002391N39 .

Statistical validity and reliability of the Persian version of the Western Ontario Meniscal Evaluation Tool (WOMET) according to the COSMIN checklist.

BACKGROUND: The Western Ontario Meniscal Evaluation Tool (WOMET) is the only questionnaire available to assess quality of life in patients with isolated meniscal injuries. The aims of this study were to prepare the Persian version of the WOMET (PWOMET) and validate it in Iranian patients with isolated meniscal tears. METHODS: In the first stage, the English version of WOMET was translated into Persian. Content validity, and qualitative and quantitative (impact score) face validity were tested by specialists and in a sample of 30 patients. In the second stage, PWOMET was assessed for the evaluation of psychometric properties in 100 patients with isolated meniscal injury and 50 healthy people based on the COSMIN checklist. Construct validity was tested based on structural validity (factor analysis) and hypothesis testing. Correlation with the total scores on the SF-36, IKDC and KOOS were used for concurrent criterion validity. Test-retest reliability and internal consistency were calculated using intraclass correlation coefficient (ICC) and Cronbach's alpha, respectively. In addition the standard error of measurement (SEM) and smallest detectable change were calculated. Interpretability was investigated as the ceiling and floor effects and minimal important difference. RESULTS: The PWOMET had acceptable qualitative face validity and content validity. The impact score (quantitative face validity) was more than 1.5 for all items. For construct validity, structural validity (factor analysis) and hypothesis testing ability were confirmed. Correlations between the PWOMET total score and IKDC, SF-36, KOOS scores were 0.61, 0.54 and 0.63, respectively (p < 0.001), thus confirming concurrent criterion validity. The intraclass correlation coefficient, Cronbach's alpha, SEM and smallest detectable change for the PWOMET were 0.73, 0.89, 9.43 and 26.13, respectively. The PWOMET had no ceiling or floor effects, and minimal important difference was 9.07. CONCLUSION: The PWOMET provides valid and reliable scores for assessment of the quality of life in patients with isolated meniscal injury.

Effects of Core Neuromuscular Training on Pain, Balance, and Functional Performance in Women With Patellofemoral Pain Syndrome: A Clinical Trial.

OBJECTIVE: The purpose of this study was to determine the effects of core neuromuscular training on pain, balance, and performance in women with patellofemoral pain syndrome (PFPS). METHODS: This randomized single-blind trial was based on a convenience sample of 28 women with unilateral PFPS. All participants were assigned randomly to the intervention or control group with a block randomization method. The control group received routine physical therapy exercise for PFPS. The intervention group received core neuromuscular training in addition to routine physical therapy exercise. The outcome measures evaluated were pain intensity (Visual Analog Scale), function (Kujala patellofemoral questionnaire and step-down performance test), and balance (Y balance test). RESULTS: In both groups the pain score was significantly lower after treatment (P = .001). The slope of this trend was greater in the intervention group. The Kujala and step-down scores improved significantly after treatment in both groups, although the improvements were greater in the intervention group. The Y balance score improved in all 3 directions after therapy in both groups (P < .05); improvement was significantly greater in the intervention group only in the posteromedial direction (P = .016). CONCLUSION: For the group of participants studied, a 4-week core neuromuscular training plus routine physiotherapy exercise was more effective than routine physiotherapy exercise alone for improving pain, balance, and functional performance in individuals with PFPS.

Patient Assessment of Constipation Quality of Life Questionnaire: Translation, Cultural Adaptation, Reliability, and Validity of the Persian Version.

BACKGROUND: The Patient Assessment of Constipation Quality of Life (PAC-QOL) questionnaire is the most validated and the most specific tool for measuring the quality of life of patients with constipation. Over 120 million people live in countries whose official language is Persian. There is no reported Persian version of the PAC-QOL questionnaire yet. The aim of this study was to translate and culturally adapt the PAC-QOL questionnaire and to assess its reliability and validity among Persian patients with chronic constipation. METHODS: Following the translation and cultural adaptation of the PAC-QOL questionnaire to Persian, 100 patients (mean±SD age=40.51±13.67) with constipation were recruited for validity measurement and 20 patients were re-examined for reliability. Content validity was assessed based on the opinions of an expert committee and the floor/ceiling effect. Construct validity was evaluated according to the hypothesis test. The SF-36 questionnaire was used for concurrent criterion validity, intra-class correlation coefficient for reliability, and Cronbach's alpha for internal consistency. RESULTS: The content validity of the PAC-QOL questionnaire was proven, and there was no floor/ceiling effect. Construct validity also was confirmed based on the hypothesis test. The overall Cronbach's alpha of the PAC-QOL questionnaire was 0.92 (range=0.72-0.92), and the overall intra-class correlation coefficient of the questionnaire was 0.88 (range=0.69-0.87). The correlation between the SF-36 and PAC-QOL questionnaires was moderate. CONCLUSION: The Persian version of the PAC-QOL questionnaire demonstrated good validity and reliability properties in chronic constipation. Accordingly, Persian researchers and clinicians can benefit from this questionnaire in further research and assessment of treatment outcomes.

Knee Injury and Osteoarthritis Outcome Score in patients with isolated meniscus injury; Validity and reliability.

BACKGROUND: The aim of this study is evaluation of the validity and reliability of the Persian version of Knee Injury and Osteoarthritis Outcome Score (KOOS) in patients with isolated meniscus injury. MATERIALS AND METHODS: One hundred people with isolated meniscal injury (29 females and 71 males with a mean age ± standard deviation [SD] = 32.37 ± 9.97 years) and fifty normal people with no knee problems (34 females and 16 males with a mean age ± SD = 28.42 ± 8.84 years) participated in this study. In patients, the duration of meniscus injury ranged from 1 month to 4 years. For evaluation of discriminate validity, we compared scores of KOOS questionnaire between patients and healthy people, and for concurrent validity, in addition to filling KOOS questionnaire, patients completed Short Form (SF-36) questionnaire, test-retest reliability with intraclass correlation coefficient) ICC), and internal consistency with Cronbach's alpha was calculated. RESULTS: Mean scores of patients (49.51 ± 17.13) and healthy people (86.01 ± 13.44) were different significantly (P < 0.001). The correlation between total score of SF-36 and KOOS was significant (r = 0.77, P < 0.001). ICC was 0.80 (ranged from 0.64-0.75) and Cronbach's alpha was 0.96 (ranged from 0.72 to 0.94). CONCLUSION: The Iranian version of KOOS is a reliable and valid tool for patients with isolated meniscus injury, so the clinicians and investigators may use this questionnaire in clinical settings and their researches.