Developing a Content Model of a Mobile-Based Application to Manage Patients with Low-Back and Neck Pain.

Introduction: As a complementary tool in health, the design of mobile applications to influence care and increase awareness of patients has grown a lot. The purpose of this study is to design and validate the content model of a mobile-based application for managing patients with low-back and neck pain. Methods: This descriptive-analytical study was conducted in two main stages to determine the content model of the application. The first stage consisted of three steps: finding the right exercise, determining the right scale to assess the pain intensity, and determining the appropriate features of the application. In the second stage, data elements collected from the previous stage were prepared in the form of a questionnaire that was given to 12 experts in physical therapy and sports medicine for validation. After collecting the questionnaire, data elements in all parts were analyzed based on the content validity ratio (CVR) and descriptive statistics indicators. Result: The content of the application was prepared in the three axes of exercises for low-back and neck pain, assessment of pain intensity, and features of the application. In the axis of sports exercises, 8 exercises for back pain and 3 exercises for neck pain were included according to the reference books. A Functional Rating Index (FRI) scale with 10 elements was selected in the axis of determining pain intensity. Also, 12 features such as the daily exercise section, using the animation, and using an audio file to explain how to do exercises were included in the model. Conclusion: According to the gaps identified in the existing applications, determining the content model of the application that is based on evidence and according to the opinion of experts is useful in improving the apps. The content model of this study was presented in 3 axes to increase the patient's willingness to do exercises, the correct way to perform exercises, conservative treatment, and check the progress of the treatment. The software developers can use these findings as a basis for designing new apps to manage low-back pain and neck pain.

Efficacy of trigger point dry needling on pain and function of the hip joint: a systematic review of randomized clinical trials.

OBJECTIVE: The objective of this study was to assess the evidence for the impact of dry needling (DN) on hip pain and function. METHODS: Medline/PubMed, Embase, Scopus, Web of Science and Cochrane CENTRAL databases were searched systematically through June 2022 for randomized clinical trials (RCTs) investigating the impact of DN on hip pain and function. Version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2) was used to assess risk of bias. Descriptive analysis was conducted to explain the outcomes and adverse events of DN in hip joint diseases. Meta-analysis was not feasible due to significant heterogeneity. RESULTS: A total of seven eligible studies (including 273 patients) were included out of 2152 screened records. Five studies were in participants with hip osteoarthritis (OA; n = 3), greater trochanteric pain syndrome (GTPS; n = 1) or piriformis syndrome (n = 1); the other two studies were conducted in healthy athletes (n = 2). Two articles assessed changes in participants' short-term visual analog scale (VAS) scores (<1 week), one of which showed that DN significantly reduced pain (P < 0.05). One-week VAS scores were analyzed in three studies, all of which demonstrated reduced scores following DN (P < 0.05). Hip range of motion (ROM) and muscle force were also improved following DN. No serious side effects were reported. CONCLUSION: DN may be safe and effective at relieving hip pain and improving hip function. DN performs significantly better than several different types of control intervention (including sham DN, no treatment, corticosteroid injections and laser). Strong evidence (high degree of certainty around the results) is lacking, and future studies should ideally use longer follow-up periods and larger sample sizes. REVIEW REGISTRATION NUMBER: CRD42022297845 (PROSPERO).

Translation, Adaptation, and Determining the Intra-Rater Reliability of the Balance Evaluation Systems Test (BESTest) for Persian Patients with Chronic Stroke.

This study aimed to translate and culturally adapt the BESTest to the Persian language and evaluate its intra-rater reliability in Iranian patients with stroke. A forward-backward translation and expert panel review method was followed. Eighteen patients post-stroke (15 men, 3 female) were included which were assessed by a physiotherapist two times with a one-week interval. The mean total score for the test and retest were 83.66 (SD = 11.98) and 82 (SD = 13.23), respectively. There were no floor and ceiling effects. The intra-rater ICC for the total score was 0.88 (95% CI = 0.73-0.95). The ICC for the BESTest sections ranged from 0.55 (95% CI = 0.12-0.80) to 0.89 (95% CI = 0.55-0.96). The standard error of measurement and the smallest detectable change of the BESTest total score were 8.33 and 22.82, respectively. Our findings confirm the intra-rater reliability of the Persian BESTest for balance assessment of patients with chronic stroke.

Outcome Measures Utilized to Assess the Efficacy of Telerehabilitation for Post-Stroke Rehabilitation: A Scoping Review.

INTRODUCTION: Outcome measures using telerehabilitation (TR) in the context of post-stroke rehabilitation are an area of emerging research. The current review assesses the literature related to TR for patients requiring post-stroke rehabilitation. The purpose of this study is to survey the outcome measures used in TR studies and to define which parts of the International Organization of Functioning are measured in trials. METHODS: TR studies were searched in Cochrane Central Register of Controlled Trials, PubMed, Embase, Scopus, Google Scholar, and Web of Science, The Cochrane Central Register of Controlled Trials (Cochrane Library), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Physiotherapy Evidence Database (PEDro) from 2016 to June 2023. Two reviewers individually assessed the full text. Discrepancies regarding inclusion or exclusion were resolved by an additional reviewer. RESULTS: A total of 24 studies were included in the current review. The findings were synthesized and presented taking into account their implications within clinical practice, areas of investigation, and strategic implementation. CONCLUSIONS: The scoping review has recognized a broad range of outcome measures utilized in TR studies, shedding light on gaps in the current literature. Furthermore, this review serves as a valuable resource for researchers and end users (such as clinicians and policymakers), providing insights into the most appropriate outcome measures for TR. There is a lack of studies examining the required follow-up after TR, emphasizing the need for future research in this area.

Narrative Microstructure and Macrostructure Skills of Persian-Speaking Children with Autism Spectrum Disorder.

Background: Studies examining narrative production skills in children with autism spectrum disorder (ASD) have demonstrated variable and inconsistent results. This study aimed to investigate to what extent narrative difficulties in children with ASD reflect difficulties with language. Methods: Accordingly, the spoken narrative skills of 16 children with ASD were compared with those of their 16 chronological age-matched (CAM) and 16 language-matched (LM) peers. A Kruskal-Wallis non-parametric test was then used to examine the differences between groups in regard to NTC, NSG and SI variables .For other studied variables (NTW, number of T-units, ATL and total score), one-way analysis of variances (ANOVA) was also used. Results: At the level of microstructure, the results showed that productivity (number of total words, total clauses, and T-unites) and syntactic complexity (average of T-unit length and subordination index) were predominantly similar in ASD and LM children. However, children with ASD scored lower than their CAM counterparts (P < 0.001). At the macrostructure level, we found that the total score of story grammar elements and the number of story grammars in the narrative production of children with ASD were lower than those in both CAM and LM children (P < 0.001). Conclusion: The present study, thus, showed that creating a coherent narrative could be more demanding for children with ASD than productivity and syntactic complexity.

The Effect of Combined Intervention on Improvement of Early Lexical Development in Minimally Verbal Children with Autism Spectrum Disorder.

Background: Autism spectrum disorder (ASD) is a neurodevelopmental disorder defined by severe communication deficits and limited and repetitive behavioral tendencies. There are several treatment approaches and methods for minimally verbal children with ASD; nonetheless, there is inconclusive evidence about how early lexical development could be improved. The present study aimed to investigate the effect of combined intervention derived from the principles of different theories-including contemporary behaviorism, schemas, sociocultural, and event representation theories-to improve early lexical development in minimally verbal children with ASD. Methods: In this single-group pretest-posttest study, 10 children with ASD (mean age, 47.9 ± 8.3 months), including 7 boys and 3 girls, participated. Participants received 16 intervention sessions in 8 weeks. The combined intervention consisted of various methods derived from contemporary behaviorism, schemas, sociocultural, and event representation approaches. The MacArthur-Bates Communicative Development Inventory 1 (Infant form) assessed early lexical development before and after intervention and after a 2-month follow-up. The Friedman test was used to analyze the data, and pairwise comparisons were performed with the Will-Coxon test. Cohen's d was used to investigate the effect sizes. Results: Significant increases in expressive vocabulary (P < 0.001) and receptive language (P < 0.001) were seen after the end of the intervention and at the follow-up (P = 0.005). Large effect sizes were found for expressive vocabulary (d = 3.7) and receptive vocabulary (d = 2.17). Conclusion: This study suggests that the combination of intervention based contemporary behaviorism, schemas, sociocultural, and event representation approaches improved receptive and expressive vocabulary in minimally verbal children with ASD.

Comparison of the immediate effects of plantar vibration of both feet with the plantar vibration of the affected foot on balance in patients with stroke: Preliminary findings.

OBJECTIVE: Plantar vibration is one of the strategies to enhance balance in stroke patients. This study compared the effects of the plantar vibration of both feet and the plantar vibration of the most affected side in patients with stroke. METHODS: This study was a single-blind clinical trial. Post-stroke patients with balance impairment were enrolled in the study and underwent two treatment sessions with a one-week interval. They received both feet's plantar vibration in one session and plantar vibration of the most affected side in the other session (frequency 100 Hz, 5 min). Mini-BESTest, Modified Modified Ashworth Scale (MMAS), and Semmes-Weinstein monofilament examination (SWME) were used to evaluate balance, spasticity, and plantar sensation, before and after the treatment sessions. RESULTS: Ten patients with a mean age of 52.9 (SD = 5.48) years were enrolled in the study. Mini-BESTest scores of balance and plantar flexor muscle spasticity were significantly improved after both feet plantar vibration and plantar vibration of the more affected side. There was no significant difference between the effectiveness of both sides plantar vibration and the most affected side plantar vibration. There were no significant improvements in SWME sensory scores after plantar vibration of either both sides or the most affected side. CONCLUSION: Plantar vibration of both sides had no additional benefits in this group of patients with chronic stroke. Plantar vibration of more affected side can be used for improving balance and plantar flexor spasticity post-stroke. The Plantar vibration had no effects on the affected foot sensibility.

Dry Needling for Arthrogenic Muscle Inhibition of Quadriceps Femoris in Patients after Reconstruction of Anterior Cruciate Ligament: a Protocol for a Randomized Controlled Trial.

Background: : Dry needling (DN) is recommended as a therapeutic modality for various neuromusculoskeletal disorders. No study has been performed on the impact of DN on arthrogenic muscle inhibition (AMI) after anterior cruciate ligament reconstruction (ACLR). This study protocol is aimed to investigate the impacts of DN on AMI of quadriceps femoris, corticomotor, and spinal reflex excitability in patients with ACLR. Methods: : A double-blind, between-subject, randomized, controlled trial will be conducted to measure changes in AMI after DN. Twenty-four subjects with ACLR will be recruited to receive a DN or a sham DN, providing that they met the inclusion criteria. Three sessions of DN on the quadriceps femoris will be applied during a one-week period. The primary outcome measures are the active motor threshold, motor evoked potential, and Hmax - Mmax ratio. The secondary outcomes are the International Knee Documentation Committee subjective knee form questionnaire score and maximum quadriceps isometric torque. Data will be collected at baseline, immediately after the first session, after the third session, and at the one-month follow-up visit. Discussion: : The results of this study will provide preliminary evidence regarding the effects of DN on AMI of quadriceps femoris in patients with ACLR.

Effects of dry needling session frequency on wrist flexor spasticity and motor recovery after stroke: a single-blind randomized clinical trial.

BACKGROUND: Determining the optimal number of dry needling (DN) sessions to satisfactorily treat a stroke patient with spasticity is important from both clinical and economic perspective. OBJECTIVE: To explore the effects of one versus three sessions of DN on spasticity of the wrist flexors and motor recovery after stroke. METHODS: In this single-blind randomized clinical trial, 24 patients were randomly and equally divided into two groups: one group received one session of DN, while the other group received three sessions of DN in one week. Both groups received one minute of DN of the flexor carpi radialis and flexor carpi ulnaris. The outcome measures were the Modified Modified Ashworth Scale (MMAS), passive resistance torque (PRT), wrist active and passive extension range of motion (ROM), and the Brunnstrom Stages of Stroke Recovery (BSSR) measured before, immediately after, and one week after the last DN session. RESULTS: Both groups demonstrated a significant improvement in all outcomes (p < .05). The MMAS scores in both groups meaningfully improved (p < .001). No significant differences were found between the two groups; however, a significant time-by-group interaction was observed for the PRT (p = .02; Cohen's d = 0.23-0.73), wrist active extension ROM (p = .001; Cohen's d = 0.37-0.67), and wrist passive extension ROM (p = .02; Cohen's d = 0.32-1.30). The BSSR significantly improved from 3 to 4 in both groups (p < .001). CONCLUSION: Administering three sessions of DN can effectively improve spasticity and motor function after stroke.

Telestroke: A Novel Approach for Post-Stroke Rehabilitation.

Despite the tremendous technologic advancements of recent years, the prevalence of stroke has increased significantly worldwide from 1990 to 2019 (a 70 [...].

Brain Analysis with a Complex Network Approach in Stroke Patients Based on Electroencephalography: A Systematic Review and Meta-Analysis.

BACKGROUND AND PURPOSE: Brain function can be networked, and these networks typically present drastic changes after having suffered a stroke. The objective of this systematic review was to compare EEG-related outcomes in adults with stroke and healthy individuals with a complex network approach. METHODS: The literature search was performed in the electronic databases PubMed, Cochrane and ScienceDirect from their inception until October 2021. RESULTS: Ten studies were selected, nine of which were cohort studies. Five of them were of good quality, whereas four were of fair quality. Six studies showed a low risk of bias, whereas the other three studies presented a moderate risk of bias. In the network analysis, different parameters such as the path length, cluster coefficient, small-world index, cohesion and functional connection were used. The effect size was small and not significant in favor of the group of healthy subjects (Hedges'g = 0.189 [-0.714, 1.093], Z = 0.582, p = 0.592). CONCLUSIONS: The systematic review found that there are structural differences between the brain network of post-stroke patients and healthy individuals as well as similarities. However, there was no specific distribution network to allows us to differentiate them and, therefore, more specialized and integrated studies are needed.

The effects of local calf vibration on balance, blood flow, and nerve conductivity in patients with diabetic peripheral neuropathy: a pilot study.

OBJECTIVES: This study aimed to evaluate the effects of local calf vibration on balance, blood flow, and nerve conductivity in patients with diabetic peripheral neuropathy (DPN). METHODS: An open-label controlled trial was designed. Patients with confirmed diagnoses of type 2 diabetes and DPN were enrolled in the study and underwent ten sessions of local calf vibration therapy for the dominant leg. The other leg was considered the control. Balance evaluation, nerve conduction studies, and color Doppler ultrasound were performed before and after the treatment course. The Wilcoxon signed rank test and the Mann-Whitney test were used to evaluate the differences between the test results before and after the intervention and between the intervention and control legs. RESULTS: Seventeen patients with a mean age of 60.3 ± 5.6 years (11 males) participated in the study. Mean Brief BESTest total scores were significantly improved (14.06 vs. 17.35; P = .01, Cohen's d = 0.743). There were no significant differences between the treated and control legs regarding the nerve conduction and color Doppler ultrasound parameters before and after the intervention (P ≥ .054). Changes in the parameters were also not significantly different between legs (P ≥ .078), except for common peroneal nerve conduction velocity, for which there was a higher increase in its value in the treated legs compared to the control legs (4.17 vs. 0.9, P = .002). CONCLUSION: Local calf vibration may positively affect balance and lower extremities nerve conduction in patients with DPN, and the findings of this study can be a basis for studies evaluating the efficacy of local calf vibration for treating DPN.

Normative values of functional reach test, single-leg stance test, and timed "UP and GO" with and without dual-task in healthy Iranian adults: A cross-sectional study.

Background: Balance impairment is a common problem in all age groups. There are several tools to assess balance. Functional reach test (FRT), single-leg stance (SLS) test, timed up and go (TUG) test, and TUG with the cognitive dual-task (TUGcog) are commonly employed balance tests. The current study aimed to determine the normative values of FRT, SLST, TUG, and TUGcog across age groups and genders in healthy Iranian adults. Methods: We designed a cross-sectional study, and 240 healthy adults (120 males and 120 females) in six age groups (18-29, 30-39, 40-49, 50-59, 60-69, ≥70 years) completed FRT, SLST, TUG, and TUGcog based on the Persian version of BESTest instructions. Results: There were significant age-specific declines in balance performances. Gender had effects on 18-29 years and older adults (≥60 years), and males performed better than females. Male and females had similar performance on the TUG and TUGcog tests in 60-69 years (p > 0.05). Conclusions: The normative values of FRT, SLS, TUG, and TUGcog provided for healthy Iranian adults increase the clinical utility of tests, and serve as a reference to estimating the individuals' balance performance across age and gender groups.

Cultural adaptation and psychometric assessment of the Persian version of the lumbar spine instability questionnaire.

BACKGROUND: The Lumbar Spine Instability Questionnaire (LSIQ) is a self-reported measure of clinical instability of the lumbar spine. This study aimed to translate and culturally adapt the LSIQ into Persian language (LSIQ-P) and to evaluate its reliability and validity in a sample of patients with chronic non-specific low back pain (LBP). METHODS: In a cross-sectional study, the LSIQ was translated using guidelines. Participants with chronic non-specific LBP, aged ≥ 18 years old, answered an online survey consisting of LSIQ-P, the Persian Functional Rating Index (FRI), and the pain Numeric Rating Scale (NRS). Construct validity, internal consistency reliability, test-retest reliability, standard error of measurement (SEM), smallest detectable change (SDC), discriminant validity, and factor analysis were evaluated. RESULTS: The LSIQ was successfully adapted into Persian. A sample of 100 participants with LBP and 100 healthy subjects completed the survey. Floor and ceiling effects were not observed. Cronbach's alpha = 0.767 and ICCagreement = 0.78 indicated good internal consistency and test-retest reliability. The SEM and SDC were 1.53 and 4.24, respectively. Construct validity of LSIQ-P was confirmed with significant correlation with Persian FRI (r = 0.44, p < 0.001) and pain NRS (r = 0.30, p = 0.003). An evidence of discriminant validity was demonstrated by significant difference in LSIQ-P total scores between the patients with LBP and healthy subjects, and between the patients with high total score ≥ 9 and those with low total score < 9 on the LSIQ-P. The LSIQ-P was found a multidimensional instrument with eight items appeared being redundant. CONCLUSIONS: The Persian LSIQ showed satisfactory metric characteristics of reliability and validity. Further studies are required to elucidate the internal structure of the LSIQ-P.

Cross-cultural Adaption, Validation and Factor Analysis of the Persian Version of the Eating Assessment Tool: EAT-10.

The eating assessment tool (EAT-10) is a self-reported questionnaire to assess the patient's perception of swallowing difficulties. The aim of this study was to cross-culturally adapt and determine validity and reliability of the Persian version of the EAT-10 (P-EAT-10) in patients with oropharyngeal dysphagia. The EAT-10 was translated into Persian language and cross-culturally adapted. One hundred patients with dysphagia (mean age ± SD = 44.44 ± 14.69 years) participated. The test-retest reliability (time interval = 7 days) was assessed in 50 patients. Intraclass correlation coefficient (ICC), standard error of measurement (SEM) and smallest detectable change (SDC) were analyzed. The Persian version of functional oral intake scale (FOIS-P) was also recorded to assess construct validity. One hundred healthy subjects completed the P-EAT-10 for clinical validity. Factor analysis was performed to determine the P-EAT-10 structure. There were no missing responses and floor or ceiling effects. Internal consistency was high (Cronbach's α 0.91). Item-total correlations exceeded acceptable standard of 0.3 for the all items (0.62-0.83). The test-retest reliability was excellent [(ICC)agreement 0.96]. The SEM and SDC were 2.61 and 7.23, respectively. Construct validity was confirmed by a significant correlation between the P-EAT-10 and FOIS-P scores (r = 0.84). Clinical validity was supported by a significant discrimination between patients and healthy subjects (t = 29.97, P < 0.001). Factor analysis indicated 2 components for the P-EAT-10. The P-EAT-10 is a valid and reliable tool and can be used in clinic and research for the assessment of oropharyngeal dysphagia in Persian-speaking patients.

Reliability and validity of Persian versions of Mini-BESTest and Brief-BESTest in persons with Parkinson's disease.

BACKGROUND: Mini-BESTest and Brief-BESTest are used to assess balance in patients with a wide range of balance disorders. While there are Persian versions of Mini-BESTest and Brief-BESTest, the psychometric properties have not been thoroughly evaluated. This study aimed to assess the reliability and validity of the Persian versions of Mini-BESTest and Brief-BESTest in persons with Parkinson's disease (PD). METHODS: Three medical students rated videotaped performances of 49 individuals with PD on the Persian Mini-BESTest, Persian Brief-BESTest, and Berg balance scale (BBS). Healthy adults were matched with persons having PD in terms of age and gender. RESULTS: There were no floor and ceiling effects. Inter- and intra-rater reliability was excellent (ICC = 0.965-0.973). The minimal detectable changes were 2.37 and 3.47 for Persian versions of Mini-BESTest and Brief-BESTest, respectively. The Persian versions of Mini-BESTest and Brief-BESTest had very good correlations with BBS (r > 0.7) confirming construct validity. There was a very good correlation between the Mini-BESTest and the Brief-BESTest total scores (r = 0.78). There were significant differences between the persons with PD and healthy adults on both tests supporting discriminant validity. Significant differences in balance performances across Hoehn and Yahr stages were found which supported known-groups validity. CONCLUSION: The Persian versions of Mini-BESTest and Brief-BESTest are reliable and valid instruments for balance evaluation in persons with PD. Further study to determine the reliability and validity of both tests when examining patients in real-time in the clinic is warranted.

Occupational Performance Outcome for Survivors of Childhood Cancer: Feasibility of the Canadian Occupational Performance Measure.

The aim of the study was to determine the feasibility of the Persian version of the Canadian Occupational Performance Measure (COPM) to assess self-reported occupational performance in a group of children with cancer at least one-year post-cancer diagnosis and intervention and to describe the self-reported occupational performance problems of children with cancer. Forty-three children with cancer (mean age 11.59 years; SD 4.94) participated in a cross-sectional study, using a convenience sampling approach. Performance and satisfaction were assessed through a validated Persian version of the COPM and feasibility and ease of administration were also considered. This study showed that feasibility was found to be adequate and this measurement was perceived as easy to understand; completion took from 20 to 51 minutes. Children with cancer prioritized 115 occupations within six of the nine COPM subcategories. Among the prioritized occupations, the highest number was found in self-care 61.7%, followed by productivity (26%), and leisure (12.1%). The mean ratings of performance varied from 3.7 to 8.4. The lowest mean rating was in the subgroup play/school (3.7). For satisfaction, the mean ratings were from 2.6 to 5.2, with functional mobility as the highest and play/school the lowest. The results support the use of the COPM in clinical practice for children with cancer. Based on these findings, children with cancer perceive problems with occupations related to all aspects of daily life. This underlines the need to provide rehabilitation services, especially occupational therapy services for these children.

The MedRisk instrument for measuring patient satisfaction with physical therapy care: A validation of the Persian-language version.

Background: Valid and reliable tools are required to measure patient satisfaction with physical therapy care. The aim of this study was to translate the MedRisk instrument for measuring patient satisfaction with physical therapy care (MRPS) into Persian language and to evaluate its measurement properties.Methods: A cross-sectional and prospective validation study design was adopted. The development of the Persian MRPS (MRPSp) followed the standard guidelines with "forward"-"backward" translation, consensus agreement of expert panel, and pilot testing. The final MRPSp was evaluated for reliability and validity.Results: A total of 114 patients (mean age 52.14 years, 72 females) participated in this study. The patients' satisfaction was high as reflected in the ceiling effect (25.4%). The overall Cronbach's α was 0.91. Corrected item-total correlations ranged from 0.22 to 0.88. Principal component analysis suggested a 7-item "internal" factor (alpha = 0.95) and a 3-item "external" factor (alpha = 0.74). The correlations of factors with two global measures of satisfaction were significant ranging from 0.247 to 0.789. Individual items of MRPSp had significant positive correlations with two global measures (r = 0.233-0.736). The standard error of measurement was between 0.97 and 2.14. The smallest detectable change was between 2.7 and 5.93.Conclusion: The Persian version of the MRPS is a two-factor reliable and valid instrument for measuring patient satisfaction with physical therapy care.

Effect of functional electrical stimulation combined with stationary cycling and sit to stand training on mobility and balance performance in a patient with traumatic brain injury: A case report.

INTRODUCTION AND IMPORTANCE: This case study investigates the effects of functional electrical stimulation, stationary cycling, and sit-to-stand training in a patient with severe chronic traumatic brain injury. CASE PRESENTATION: The participant was a 24-year-old man with a traumatic brain injury two years prior to the intervention described in this case report. The accident caused right hemiplegia, right foot drop, aphasia, and poor coordination of movement in both upper and lower limbs. He was using a wheeled walker for functional mobility and was receiving routine rehabilitation before the initiation of treatment. A four week intervention in this study included functional electrical stimulation of the quadriceps and tibialis anterior muscles combined with stationary cycling and sit-to-stand training. CLINICAL DISCUSSION: Active and passive range of motion of right ankle dorsiflexion, strength of ankle dorsiflexor, balance performance, and mobility were measured before and after the intervention. Active range of motion of right ankle dorsiflexion increased by 8°. In addition, manual muscle test and Brief-BESTest scores increased from 3+ to 5 and from 7 to 9, respectively. Walking speed over the 10-m distance and timed up and go test score improved. CONCLUSION: Functional electrical stimulation combined with stationary cycling and sit-to-stand training resulted in increased muscle strength and range of motion, improved balance performance, and improved mobility in an individual with a traumatic brain injury.

The Persian Brief Illness Perception Questionnaire: Validation in Patients with Chronic Nonspecific Low Back Pain.

BACKGROUND: Illness perceptions may influence coping behaviors as well as treatment and recovery among patients with chronic pain including low back pain (LBP). These perceptions may vary across different conditions. The Brief Illness Perception Questionnaire (BIPQ) is used as an instrument to assess the patients' perception of illness. Although the BIPQ has been previously translated into Persian, its psychometric properties have not been evaluated among patients with chronic nonspecific LBP. The aim of this study was to determine the reliability and validity of the Persian BIPQ in patients with chronic nonspecific LBP. METHODS: 116 patients with chronic nonspecific LBP with a mean (standard deviation) age of 36.4 years (10.7) participated in this cross-sectional study. Fifty patients were reexamined after 10 to 12 days for test-retest reliability. Internal consistency reliability, construct validity, concurrent criterion validity, and structural validity were evaluated. The concurrent validity was examined by using the Short Form-36 Health Survey. RESULTS: There were no floor and ceiling effects. Cronbach's alpha for the total score was 0.90. The intraclass correlation coefficient (ICC) for test-retest reliability was 0.90. The standard error of measurement and the minimal detectable change was found to be 3.26 and 9.04, respectively. The convergent correlations confirmed the construct validity. The concurrent criterion validity was demonstrated by significant negative correlations with the SF-36. The Exploratory Factor Analysis produced the 2 factors (emotional illness representations and cognitive illness representations) with an eigenvalue >1.0 that jointly accounted for 58.86% of the total variance. CONCLUSION: The Persian BIPQ is a reliable and 2-factor instrument and can be used for assessing illness perception in patients with chronic nonspecific LBP.