Post-COVID-19 physical and cognitive impairments and associations with quality of life: a cross-sectional study.

Background and objective: This study aimed to compare physical and cognitive functions between post-coronavirus disease 2019 (COVID-19) participants and healthy matched controls and investigate associations between physical and cognitive impairments with quality of life. Methods: Twenty-three post-COVID-19 participants and 23 age and sex-matched healthy people without a history of COVID-19 were included. Physical function was assessed using the Medical Research Council Sum Score (MRC-SS), 2 min Step Test, Modified Borg Scale, and Short Physical Performance Battery (SPPB) Test. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), Trail Making Test (TMT), and Stroop test, and the quality of life was evaluated using the Euro Quality of Life-5 Dimensions-3 Levels (EQ-5D-3l) questionnaire. Assessments were performed by a physical therapist in one session. Results: Mann-Whitney U test showed that in the post-COVID-19 group, compared to the control group, the number of steps in the 2 min Step Test (p < 0.001, ES = 0.57) and the scores of the SPPB (p = 0.03, ES = 0.32), MoCA (p = 0.003, ES = 0.44), Stroop test (p < 0.001, ES = 0.75), and the EQ-5D-3l visual analog scale (p = 0.027, ES = 0.32) were significantly lower. In addition, the Modified Borg Scale score (p < 0.001, ES = 0.6), TMT-A (p = 0.013, ES = 0.36) and TMT-B (p = 0.016, ES = 0.35) times, and the Stroop time (p < 0.001, ES = 0.61) were significantly higher in the post-COVID-19 group. There were no significant between-group differences in the MRC-SS score (p = 0.055, ES = 0.28). Furthermore, there were significant moderate to high associations between physical and cognitive functions and the quality of life in post-COVID-19 participants. Conclusions: On average 4 months after symptomatic COVID-19, post-COVID-19 participants had significant impairments in physical and cognitive functions compared to healthy matched controls that were significantly correlated with the quality of life. These findings highlight the need for a comprehensive assessment to plan appropriate management strategies.

Effectiveness of telerehabilitation intervention to improve pain and physical function in people with patellofemoral pain syndrome: study protocol for a randomized controlled trial.

BACKGROUND: Patellofemoral pain syndrome (PFPS) is a common musculoskeletal condition in young and active adults. Exercise therapy is an essential part of rehabilitation in people with PFPS (PwPFPS). Telerehabilitation is an innovative treatment approach that has been used in several musculoskeletal conditions. This study aims to investigate the non-inferiority of telerehabilitation through a smartphone application, the Vito App, compared to face-to-face physical therapy on reducing pain and improving physical function, quality of life, and psychological factors. METHODS: This randomized controlled trial will include 60 PwPFPS. to a control group (face-to-face physical therapy) or an experimental group (telerehabilitation). The intervention for both groups consists of stretching, strengthening, balance, and functional exercises for 6 weeks and three sessions per week. The primary outcomes are pain intensity by visual analog scale (VAS), physical function by the Kujala questionnaire and functional tests including the bilateral squat, anteromedial lunge, and step down, and quality of life by the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire quality of life subscale. Secondary outcomes are psychological factors such as anxiety and depression assessed with the Hospital Anxiety and Depression Scale (HADS) questionnaire, kinesiophobia assessed with the Tampa scale, and pain catastrophizing assessed with the Pain Catastrophizing Scale (PCS). Assessments will be held in 3 phases: pre-test (before the intervention), post-test (after the 6 weeks of intervention), and follow-up (1 month after the end of the intervention). DISCUSSION: We expect that both the control group and experimental group will show similar improvements in clinical and psychological outcome measures. If our hypothesis becomes true, PwPFPS can use telerehabilitation as a practical treatment approach. Telerehabilitation can also enhance accessibility to rehabilitation services for active adults and for people living in remote and rural areas. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (IRCT) IRCT20201112049361N1. Registered on 29 October 2022.

Responsiveness and minimal clinically important changes to physical therapy interventions of Persian versions of copenhagen neck functional disability index, neck bournemouth questionnaire and spine functional index questionnaires in people with chronic neck pain.

BACKGROUND AND PURPOSE: Chronic neck pain has a significant impact on the patient's quality of life. Specific outcome measures like Copenhagen Neck Functional Disability Index (CNFDI), Neck Bournemouth questionnaire (NBQ), and Spine Functional Index (SFI) are reliable and valid measures that have been used for comprehensively evaluating neck-related disabilities. However, responsiveness has not yet been investigated. The aim of this study was to examine the responsiveness and clinically meaningful changes of the CNFDI, NBQ, and SFI for Persian patients with chronic neck pain. METHODS: Prospective recruitment of 145 patients with chronic neck pain was conducted. Participants completed the Persian versions of CNFDI, NBQ, and SFI at baseline and after 4 weeks of physical therapy. Also, the Global Rating of Change Scale (GRCS) was completed in the post-intervention assessment. The Receiver Operating Characteristics (ROC) curve and correlational analysis were used for evaluating the responsiveness. In addition, the Minimal Clinically Important Change (MCIC) was determined. RESULTS: All selected outcome measures revealed an area under the curve of 0.96. The MCICs of 10, 7, and 10 points were found for the CNFDI, NBQ, and SFI, respectively. The results showed an excellent Gamma correlation coefficient of the CNFDI (γ = 0.98), NBQ (γ = 0.99), and SFI (γ = 0.99) with the GRCS. CONCLUSION: The Persian versions of the CNFDI, NBQ, and SFI have acceptable responsiveness properties for evaluating the changes in health status in patients with chronic neck pain following physical therapy interventions.

Cross-Cultural Adaptation and Validation of the Persian Version of the Functional Arm Scale for Throwers.

BACKGROUND: The Functional Arm Scale for Throwers (FAST) is a reliable and valid region-specific tool designed to evaluate health-related quality of life in throwing athletes with upper-extremity injuries. The purpose of this study was to adapt, translate, and evaluate the psychometric properties of the Persian version of the Functional Arm Scale (FAST-Persian) for use in throwing athletes. MATERIALS AND METHODS: The study was conducted based on 5 steps of cross-cultural adaptation including forward translation, synthesis, backward translation, expert committee review, and pretesting. The final Persian questionnaire, along with Persian versions of Disabilities of the Arm, Shoulder, and Hand and Kerlan-Jobe Orthopedic Clinic questionnaires, was completed by 177 throwing athletes for validity analysis. After 7 to 14 days, the FAST-Persian was reanswered by 80 throwers, who had no changes in this time interval. Internal consistency and test retest reliability were used to evaluate reliability of the questionnaire. Standard error of measurement and smallest detectable changes were also calculated. Construct validity was determined by correlational analysis with Disabilities of the Arm, Shoulder, and Hand and Kerlan-Jobe Orthopedic Clinic questionnaires. Dimensionality was evaluated with factor analysis. RESULT: Cronbachs alpha was .99, and the interclass correlation coefficient levels for total score and 5 subscales of the FAST-Persian ranged between .98 and .99. The standard error of measurement and smallest detectable changes were 3.17 and 8.80, respectively. The FAST-Persian had a high correlation with Disabilities of the Arm, Shoulder, and Hand (r = .98, P < .0001) and Kerlan-Jobe Orthopedic Clinic (r = .98, P < .0001) scores. Factor analysis revealed one factor with a total variance of 75.23%. CONCLUSION: The FAST-Persian is a reliable and valid measurement tool that can be used to evaluate health-related quality of life in overhead athletes and throwers.

The Effect of McGill Core Stability Training on Movement Patterns, Shooting Accuracy, and Throwing Performance in Male Basketball Players: A Randomized Controlled Trial.

CONTEXT: Core stability training has been recommended as a vital element in improving movement's pattern and athletic performance. The main objective of this study was to investigate the effect of 12-week McGill core stability training on movement patterns, shooting accuracy, and throwing performance. DESIGN: Randomized controlled clinical trial. SETTING: University research laboratory. METHODS: Forty male basketball players were randomly assigned to experimental and control groups. The experimental group completed 12-week McGill core stability training, while the control group completed routine exercise training. Patterns of functional movements was measured through functional movement screen (FMS), shooting accuracy measured by static 3-point shooting (S3P) and dynamic 60-second 3-point shooting test, and throwing performance measured by Functional Throwing Performance Index. RESULTS: Comparison revealed that regardless of received training, after 12 weeks both groups showed significant improvement in all outcome measures. However, experimental group had significantly higher post test scores in FMS (P = .02), S3P (P = .007), and dynamic 60-second 3-point shooting test (P = .01). For Functional Throwing Performance Index, there was no group differences (P = .96). The results of follow-up assessments showed for all measurements including FMS (P = .03), S3P (P = .004), dynamic 60-second 3-point shooting test (P < .001), and Functional Throwing Performance Index (P = .005); experimental group had higher scores than the control group. CONCLUSIONS: According to the results, implementing McGill core stability training in basketball routine training would be advisable since significant improvement can be obtained in the measured parameters.

Traditional physical therapy exercises combined with sensorimotor training: The effects on clinical outcomes for chronic neck pain in a double-blind, randomized controlled trial.

OBJECTIVE: This study examined the effects of combining traditional physical therapy exercises with sensorimotor training on joint position sense, pain, muscle endurance, balance and disability in patients with chronic, non-specific neck pain. DESIGN: Double-blind, randomized controlled trial. SUBJECTS: A total of 53 patients with chronic non-specific neck pain were randomized to either traditional or combined exercise groups. INTERVENTIONS: All patients received 12 sessions of supervised intervention 3 times per week. The traditional group performed traditional exercises, and the combined exercise group performed sensorimotor training in addition to traditional exercises. OUTCOME MEASURES: Joint position sense, pain, neck flexor muscle endurance test, 10 Meter Walk Test, step test, and the Neck Disability Index. RESULTS: The combined exercise group showed significantly greater improvement compared to the traditional group in joint position sense during extension, flexion, right rotation, the 10 m walk test with head turn, and the step test. Pain intensity, muscle endurance, and disability improved in both groups. Additionally, there was a higher degree of effect on muscle endurance in the combined exercise group compared to a moderate effect in the traditional group. CONCLUSIONS: A combination of sensorimotor training with traditional physical therapy exercises could be more effective than traditional exercises alone in improving joint position sense, endurance, dynamic balance and walking speed.

Relationship between functional balance and walking ability in individuals with chronic stroke.

[Purpose] The objective of this cross sectional study was to investigate the validity of Functional Ambulation Category in evaluating functional balance and identifying the relationship between balance impairment and functional ambulation in individuals with chronic stroke. [Participants and Methods] A total of 31 chronic stroke patients with first ever ischemic middle cerebral artery strokes, with no cognitive deficits were recruited. Participants had a mean age of 54.84 (SD=7.05) years and a time after stroke of 22.74 (SD=27.13) months. Community ambulation was determined by Functional Ambulation Category and functional balance was assessed by Berg Balance Scale. [Results] The mean Berg Balance Scale and the Functional Ambulation Category scores were 47.38 (SD=7.54) and 3.8 (SD=0.79), respectively. Correlation analysis revealed that balance impairment and ambulatory function was significantly positively correlated with each other (r=0.80). [Conclusion] The results shows that the Functional Ambulation Category is a valid tool in evaluating functional balance and suggest that functional balance may be an important goal for rehabilitation to achieve improvement in walking ability in people with chronic stroke.

Postural stability in patients with non-specific chronic neck pain: A comparative study with healthy people.

Background: Impairment of cervical sensory input in patients with neck pain may disturb postural stability. The purpose of present study was to assess the dynamic postural stability of subjects with chronic neck pain compared to a matched control group. Methods: In this case-control study, 22 chronic non-specific neck pain and 22 healthy individuals participated. Postural stability was measured with Techno-body Prokin tilting platform. Subjects performed balance tests under two conditions: eyes open and closed. The parameters for assessment of postural stability were total stability index (TSI), anteroposterior stability index (APSI), mediolateral stability index (MLSI), and trunk deviation which demonstrated total trunk sway in medio-lateral and antero-posterior. We used a separate 2 (group) by 2 (postural difficulty) mixed-design analysis of variance (ANOVA) for analysis of postural performance. Results: There were significant differences between the chronic neck pain and matched control groups in APSI, MLSI, and TSI, p<0.001 in both eyes opened and closed conditions. The trunk deviation was greater for non-specific neck pain in comparison to healthy subjects, p<0.05 in both conditions of eyes open and closed. Conclusion: The results of this study showed that patients with chronic neck pain have poorer postural control than healthy subjects. The findings suggest that clinicians take into account the importance of dynamic postural stability assessment in patients with chronic non-specific neck pain and consider the application of intervention programs for improvement of the dynamic balance.

Effects of narrow-base walking and dual tasking on gait spatiotemporal characteristics in anterior cruciate ligament-injured adults compared to healthy adults.

PURPOSE: The present experiment was conducted to examine the hypothesis that challenging control through narrow-base walking and/or dual tasking affects ACL-injured adults more than healthy control adults. METHODS: Twenty male ACL-injured adults and twenty healthy male adults walked on a treadmill at a comfortable speed under two base-of-support conditions, normal-base versus narrow-base, with and without a cognitive task. Gait patterns were assessed using mean and variability of step length and mean and variability of step velocity. Cognitive performance was assessed using the number of correct counts in a backward counting task. RESULTS: Narrow-base walking resulted in a larger decrease in step length and a more pronounced increase in variability of step length and of step velocity in ACL-injured adults than in healthy adults. For most of the gait parameters and for backward counting performance, the dual-tasking effect was similar between the two groups. CONCLUSIONS: ACL-injured adults adopt a more conservative and more unstable gait pattern during narrow-base walking. This can be largely explained by deficits of postural control in ACL-injured adults, which impairs gait under more balance-demanding conditions. The observation that the dual-tasking effect did not differ between the groups may be explained by the fact that walking is an automatic process that involves minimal use of attentional resources, even after ACL injury. Clinicians should consider the need to include aspects of terrain complexity, such as walking on a narrow walkway, in gait assessment and training of patients with ACL injury. LEVEL OF EVIDENCE: III.

Responsiveness and minimally important differences for selected Persian-version of outcome measures used in patients with patellofemoral pain syndrome.

PURPOSE: To investigate the responsiveness and determine the minimally important differences (MID) of Persian versions of the Kujala patellofemoral scale (KPS), lower extremity functional scale (LEFS), and functional index questionnaire (FIQ) in patients with patellofemoral pain syndrome (PFPS). METHOD: Outcome measures including the Persian KPS, LEFS, and FIQ were administered to 233 patients at baseline and then again 4 weeks after physiotherapy. Moreover, the 7-point global rating scale was completed by the patients at 4 weeks. Responsiveness was evaluated using the correlation analysis and the receiver operating characteristics (ROC) method. RESULTS: Correlation analysis showed that the relationship of all outcome measures with the global rating scale falls within the fair range of relationship (Gamma = 0.26-0.40). Moreover, the results of ROC analysis showed that the all outcome measures have acceptable high responsiveness index. Furthermore, the MIDs of 9.5, 4.5, and 1.5 points were obtained for the Persian KPS, LEFS, and FIQ, respectively. CONCLUSIONS: The Persian-versions of all outcome measures are responsive for evaluating change following physiotherapy intervention. The MID values obtained in this study will help the clinicians and researchers to determine if a patient with PFPS has experienced a true change following a physiotherapy intervention. Implications for Rehabilitation Persian-versions of the KPS, LEFS, and FIQ can be used as three "responsive" outcome measures in clinical studies of patients with patellofemoral pain syndrome (PFPS). These assessment tools have clinical relevance for rehabilitation specialists working on patients with PFPS. The minimally important differences provide valuable information for the clinicians and researchers to make decision about the identification of a clinical change in health status of patients with PFPS.

Intra-limb coordination while walking is affected by cognitive load and walking speed.

Knowledge about intra-limb coordination (ILC) during challenging walking conditions provides insight into the adaptability of central nervous system (CNS) for controlling human gait. We assessed the effects of cognitive load and speed on the pattern and variability of the ILC in young people during walking. Thirty healthy young people (19 female and 11 male) participated in this study. They were asked to perform 9 walking trials on a treadmill, including walking at three paces (preferred, slower and faster) either without a cognitive task (single-task walking) or while subtracting 1׳s or 3׳s from a random three-digit number (simple and complex dual-task walking, respectively). Deviation phase (DP) and mean absolute relative phase (MARP) values-indicators of variability and phase dynamic of ILC, respectively-were calculated using the data collected by a motion capture system. We used a two-way repeated measure analysis of variance for statistical analysis. The results showed that cognitive load had a significant main effect on DP of right shank-foot and thigh-shank, left shank-foot and pelvis-thigh (p<0.05), and MARP of both thigh-shank segments (p<0.01). In addition, the main effect of walking speed was significant on DP of all segments in each side and MARP of both thigh-shank and pelvis-thigh segments (p<0.001). The interaction of cognitive load and walking speed was only significant for MARP values of left shank-foot and right pelvis-thigh (p<0.05 and p<0.001, respectively). We suggest that cognitive load and speed could significantly affect the ILC and variability and phase dynamic during walking.

Reliability and validity of the Persian lower extremity functional scale (LEFS) in a heterogeneous sample of outpatients with lower limb musculoskeletal disorders.

PURPOSE: The aim was to culturally translate and validate the Persian lower extremity functional scale (LEFS) in a heterogeneous sample of outpatients with lower extremity musculoskeletal disorders (n = 304). METHOD: This is a prospective methodological study. After a standard forward-backward translation, psychometric properties were assessed in terms of test-retest reliability, internal consistency, construct validity, dimensionality, and ceiling or floor effects. RESULTS: The acceptable level of intraclass correlation coefficient >0.70 and Cronbach's alpha coefficient >0.70 was obtained for the Persian LEFS. Correlations between Persian LEFS and Short-Form 36 Health Survey (SF-36) subscales of Physical Health component (rs range = 0.38-0.78) were higher than correlations between Persian LEFS and SF-36 subscales of Mental Health component (rs range = 0.15-0.39). A corrected item--total correlation of >0.40 (Spearman's rho) was obtained for all items of the Persian LEFS. Horn's parallel analysis detected a total of two factors. No ceiling or floor effects were detected for the Persian LEFS. CONCLUSIONS: The Persian version of the LEFS is a reliable and valid instrument that can be used to measure functional status in Persian-speaking patients with different musculoskeletal disorders of the lower extremity. Implications for Rehabilitation The Persian lower extremity functional scale (LEFS) is a reliable, internally consistent and valid instrument, with no ceiling or floor effects, to determine functional status of heterogeneous patients with musculoskeletal disorders of the lower extremity. The Persian version of the LEFS can be used in clinical and research settings to measure function in Iranian patients with different musculoskeletal disorders of the lower extremity.