The effect of trunk-stabilizing muscle training in women with stress urinary incontinence: A randomized controlled trial.

INTRODUCTION: There is little evidence regarding the effect of trunk-stabilizing muscle training on the improvement of stress urinary incontinence (SUI) symptoms. OBJECTIVE: To investigate the effect of trunk-stabilizing muscle training on transabdominal ultrasonography (TAUS) and clinical urological indices, and on the quality of life (QoL) in women with SUI. DESIGN: Randomized controlled trial. SETTING: A university hospital. PARTICIPANTS: Forty-six women with SUI, ages 20-55 years, were randomly assigned to an experimental (n = 23) and control group (n = 23). INTERVENTIONS: The experimental group performed trunk-stabilization exercises according to the Sapsford protocol, whereas the control group performed pelvic floor muscle (PFM) exercises for 8 weeks. MAIN OUTCOME MEASURES: The primary outcome measure was bladder base displacement (BBD), assessed by TAUS during PFM contraction (PFMC), Valsalva, and abdominal curl. The secondary outcome measures were PFM strength, the severity of urinary incontinence (UI), voiding diary, and QoL, assessed by the Modified Oxford Grading System, the severity index, frequency chart, and lower urinary tract symptoms-QoL questionnaire, respectively. All variables were assessed at baseline and after 8 weeks of intervention. RESULTS: The interaction of group and time was not significant for BBD during PFMC (p = .98), Valsalva (p = .28), abdominal curl (p = .34), and secondary variables (p > .05). The main effect of time was significant in both groups for BBD during PFMC, PFM strength, the severity of UI, voiding diary, and QoL (p < .001), with effect size (d) of 0.30, 0.80, 2.05, 1.07, and 1.03 in the control; and 0.49, 0.52, 1.75, 0.66, and 0.88 in the experimental group, respectively. The main effect of the group was not significant for BBD during PFMC (p = .68), Valsalva (p = .22), abdominal curl (p = .53), and secondary variables (p > .05). CONCLUSIONS: Trunk-stabilizing muscle training and PFM exercise are equally effective in the improvement of PFM function, UI symptoms, and QoL in women with SUI. Both methods can be used interchangeably by physical therapists.

Walking Performance during Concurrent Cognitive and Motor Tasks in Individuals with Nonspecific Chronic Low Back Pain: A Case-Control Study.

Background: The present study aimed to compare the effects of simultaneous cognitive and motor tasks on walking performance between individuals with nonspecific chronic low back pain (NSCLBP) and healthy controls. Methods: A total of 20 patients with NSCLBP and 20 healthy controls participated in this study. They walked at their self-selected speed on a treadmill under 3 walking conditions in a randomized order: walking only, walking while performing a concurrent cognitive task, and walking while performing a concurrent motor task. Two-way repeated measure analysis of variance with additional post hoc comparison (Bonferroni test) was used to evaluate the effects of group and walking conditions on gait parameters. Results: The result showed a significant main effect of the group for swing time ( P = 0.012) and double support time (P = 0.021) in those with NSCLBP compared with healthy controls. Moreover, there was a significant interaction between the group and condition for cadence ( P = 0.004) and step width variability (P = 0.016).Regarding stride length variability and stride time variability, the analysis indicated a significant effect of condition (P = 0.002 and P = 0.030, respectively). In both groups, no significant differences were observed in gait parameters between motor dual task and single walking ( P > 0.05). Conclusion: Our findings indicated that those with NSCLBP adapted successfully to walking performance to maintain the performance of the concurrent cognitive task under the cognitive dual-task walking condition. Moreover, the present study observed no dual-task interference under the motor dual-task condition.

The effects of intrinsic foot muscles strengthening exercises on foot kinetic parameters in pronated foot subjects during forward jump landing.

Background: Pronated foot is one of the most important factors that may lead to musculoskeletal injuries of the lower extremities. Among all treatments for this disorder, intrinsic foot muscles strengthening exercises (IFMSE) have an important role in management of the individuals with pronated foot. Although the effect of the IFMSE is well accepted in this population; however, their impacts on foot kinetic are yet to be clarified. The present study aims to identify the effects of the IFMSE on foot kinetic parameters in pronated foot individuals during forward jump landing. Materials and Methods: In this quasi-experimental study, 20 asymptomatic male and female subjects (mean age of 22.65 ± 2.51 years) with pronated foot structures were selected by using a simple non-random sampling method. The ground reaction force (GRF), rate of loading (ROL), and the resultant vector of time to stabilization (RVTTS) were examined during a forward jump landing task by using a force plate before and after six weeks of the IFMSE. Result: The findings showed that the following parameters were not significantly change before and after of the IFMSE: GRF (1.97 ± 0.49 vs. 2.03 ± 0.54, P =0.667), ROL (.09 ±0.12 vs. 08 ±.12, P =.632), and RVTTS (2836.60 ± 1144.62 vs. 2644.35 ± 704.71, P =.479). Conclusion: In the pronated feet subjects, the IFMSE alone was not capable of changing the kinetic parameters of the foot, or the duration of using these exercises. In this study, six weeks may not be enough to make changes the foot kinetic parameters and therefore these exercises should be used for a longer period of time.

Validity and reliability of the Persian version of the STarT musculoskeletal tool.

BACKGROUND: The Subgrouping for Targeted Treatment (STarT) musculoskeletal (MSK) tool stratifies patients with MSK disorders (MSDs) into prognostic categories based on poor outcomes. PURPOSE: This study aimed at investigating the validity and reliability of the Persian STarT MSK tool in people suffering from painful MSDs in Iran. METHODS: A total of 593 subjects with painful MSDs including neck, shoulder, low back, knee, and multisite pain received and completed the STarT MSK tool, visual analog scale (VAS), EuroQol five-dimensions three-levels questionnaire (EQ-5D-3 L), short form-36 health survey questionnaire (SF-36), and Örebro musculoskeletal pain screening questionnaire (ÖMPSQ) in the first visit. To examine test-retest reliability, 234 patients completed the STarT MSK tool 2 days after the initial visit. RESULTS: In this study, 139 (23.5%), 266 (44.9%), and 188 (31.7%) participants were classified as low-, medium-, and high-risk groupings for poor outcomes, respectively. Spearman's correlation coefficient showed a strong relationship among Persian STarT MSK tool and EQ-5D-3 L (-0.78), SF-36 (-0.76), and OMPSQ (0.70). The results of known-group validity indicated that this tool could distinguish among the participants in different risk subgroups based on the scores of the ÖMPSQ, VAS, SF36, and EQ-5D-5 L (p < .001). No ceiling and floor effects were observed. Cronbach's alpha and intra-class correlation coefficient (ICC2,1) were acceptable (0.71) and excellent (0.98), respectively. CONCLUSION: The Persian version of STarT MSK tool has shown to be a valid and reliable instrument to stratify people with painful MSDs into low-, medium-, and high-risk subgroups based on persistent pain disability.

Comparing the Effects of Single-Task versus Dual-Task Balance Training on Gait Smoothness and Functional Balance in Community-Dwelling Older Adults: A Randomized Controlled Trial.

To compare the effects of single- versus dual-task balance training on the gait smoothness and balance of community-dwelling older adults, 69 volunteers were randomized to single-, dual-task training, and control (no intervention) groups. Exercises were received in 18 sessions through 6 weeks. The gait smoothness was measured by the harmonic ratio of trunk accelerations using a triaxial accelerometer. Balance performance was assessed through the Fullerton Advanced Balance scale, Timed Up and Go test, Activities-specific Balance Confidence, and gait speed. After the trial, all variables improved significantly in the training groups. Moreover, differences in the mean change of all variables, except the Timed Up and Go test, were statistically significant between the interventional groups and the control group, but no significant difference was reported between the two training groups. This study suggests that balance training can improve gait smoothness as well as balance status in healthy older adults.

Effects of Medial Thrust Gait on Lower Extremity Kinetics in Patients with Knee Osteoarthritis.

BACKGROUND: Medial thrust (MT) gait is a nonsurgical approach for reducing the knee adduction moment (KAM) in patients with knee osteoarthritis. However, its usefulness is indeterminate due to scarcity of research about changes in lower extremity kinetics and the ground reaction force (GRF) which have been investigated in this study. MATERIALS AND METHODS: Twenty patients (6 males, 14 females, age: 56.2±6.2 years) with medial knee osteo-arthritis participated in this cross-sectional study. A 12-camera motion analysis system and two force plates recorded kinematic and GRF data while participants walked barefoot along a 12m path with 1) their regular gait pattern and 2) MT gait pattern. The first peak adduction and flexion moments of the hip, knee, and ankle, and the sagittal and frontal GRF were measured. The center of pressure (CoP) location in the mediolateral direction at first KAM peak was also determined. RESULTS: MT gait significantly reduced the first KAM peak (mean difference= 169.7, p<0.001) and the hip flexion moment (mean difference: 82.6, p= 0.020) compared to normal gait. The mediolateral CoP significantly shifted laterally during MT gait compared to normal gait (mean difference: -12% foot width, p<0.001). There was no significant difference in other kinetics variables between the two gait patterns (p>0.05). CONCLUSIONS: 1. Our findings show that MT gait can reduce the KAM with no significant increase in the GRF and other lower extremity moments. 2. The results suggest that the reduced KAM associated with MT gait is caused by a lateral shift of the CoP, resulting in a reduced GRF moment arm.

Effects of an Exercise Therapy Targeting Knee Kinetics on Pain, Function, and Gait Kinetics in Patients With Knee Osteoarthritis: A Randomized Clinical Trial.

In this study, the effects of an exercise therapy comprising yoga exercises and medial-thrust gait (YogaMT) on lower-extremity kinetics, pain, and function in patients with medial knee osteoarthritis were investigated. Fifty-nine patients were randomly allocated to three treatment groups: (a) the YogaMT group practiced yoga exercises and medial thrust gait, (b) the knee-strengthening group performed quadriceps- and hamstring-strengthening exercises, and (c) the treadmill walking group practiced normal treadmill walking in 12 supervised sessions. The adduction and flexion moments of the hip, knee, and ankle; pain intensity; and 2-min walking test were assessed before and after treatment and at 1-month follow-up. The YogaMT group experienced a significant reduction in knee adduction moment. All groups showed significant improvement in pain and function. The YogaMT may reduce medial knee load in patients with knee osteoarthritis in the short term. A larger clinical trial is required to investigate the long-term outcomes of this intervention.

Transabdominal Ultrasound Imaging of Pelvic Floor Muscle Activity in Women With and Without Stress Urinary Incontinence: A Case-Control Study.

OBJECTIVE: Transabdominal ultrasound (TAU) is an easy and noninvasive way to evaluate and retrain pelvic floor muscle (PFM) function. The purpose of this study was to compare PFM activity in women with and without urinary incontinence (UI) by measuring bladder base displacement (as a marker for PFM activity) using TAU during PFM contraction, Valsalva's maneuver, and abdominal curl. METHODS: Sixty-three women, aged 20-55 years, volunteered to participate in this cross-sectional study: 21 were continent and 42 had UI (21 stress urinary incontinence [SUI] and 21 mixed urinary incontinence [MUI]). Mean bladder base displacement in millimeters was measured to evaluate differences between the three groups (continent, SUI, and MUI) and also between the continent and UI groups during the performance of each maneuver. RESULTS: No significant differences were seen between the three groups in bladder base elevation during PFM contraction (P > 0.05). Descent of the bladder base during Valsalva's maneuver and abdominal curl was significantly greater in women with SUI and MUI than in women in the continent group (P < 0.05). Comparison of the continent and UI groups showed no significant differences in elevation of the bladder base during PFM contraction, while descent of the bladder base was significantly greater in women with UI than in women in the continent group during Valsalva's maneuver and abdominal curl (P < 0.05). CONCLUSION: TAU indicated that bladder base descent was greater in women with SUI and MUI than those in the continent group during the performance of maneuvers that increased intra-abdominal pressure. This effect may be due to decreased PFM performance in women with urinary incontinence.

The Physiological Cost Index and Some Kinematic Parameters of Walking and Jogging in Blind and Sighted Students.

BACKGROUND: Vision plays an important role in supporting efficient locomotion. The present study aimed to measure the physiological cost index (PCI) and some kinematic parameters of preferred walking and jogging in blind and sighted students. METHODS: A cross-sectional study was conducted among blind (n=18) and sighted (n=27) students aged 8-16 years. The following parameters were measured during a standard test procedure: step length (meter), cadence (steps/min), mean speed (meter/min), and the PCI of preferred walking (PCIW) and jogging (PCIJ) over a distance of 100 meters. RESULTS: Univariate linear regression analysis revealed that the weight of an individual as well as the test duration were significant predictors of heart rate (HR) and PCI. Overall, the PCI (beats/meter) of sighted (PCIW=0.22±0.08 and PCIJ=0.24±0.07) and blind students (PCIW=0.27±0.07 and PCIJ=0.31±0.08) were significantly different (all P≤0.05). In addition, the speed of preferred walking (PW) in sighted students was significantly higher than that of the blind students (67±8 versus 62.8±9 m/min; all P≤0.05), while this difference was insignificant in jogging mode (105±9 versus 102±11 m/min). CONCLUSION: Although the blind students were familiar with the ambient environment and the walking route, they demonstrated a different pattern of PW and jogging modes with respect to kinematic parameters. We also demonstrated that the blind students spent more energy (i.e., PCI) to achieve a lower or equal gait kinematics compared to the sighted students.

Clustering of patients with chronic low back pain in terms of physical and psychological factors: A cross-sectional study based on the STarT Back Screening Tool.

BACKGROUND: The STarT Back Screening Tool (SBT) is a multidimensional questionnaire consisting of physical and psychological factors which categorizes the patients in the low, medium or high risk subgroups. OBJECTIVE: To investigate the relationship between SBT-based subgrouping and clustering of patients with LBP using uni-dimensional psychological, clinical and physical examination measures. METHODS: One hundred and fifty-seven patients with chronic LBP completed the SBT and uni-dimensional psychological, disability and pain questionnaires. Physical impairments were evaluated through the Physical Impairment Index (PII). Hierarchical and K-means methods were used for cluster analysis. Between-clusters differences and the association between the clusters and SBT-based subgrouping were investigated. RESULTS: Three clusters were identified. The derived clusters were labeled severe, moderate and mild physical-psychological-distress clusters, because pain intensity, disability, psychological and physical factors were relatively high, moderate or low, respectively. Most of the patients in moderate and mild physical-psychological distress clusters were categorized as medium risk based on SBT. The mean difference for the PII was higher than that of psychological factors between moderate and mild physical-psychological-distress clusters. CONCLUSIONS: Patients in low and high risk subgroups of SBT were sufficiently differentiated, but patients in a medium risk subgroup had a different profile based on PII. Including additional physical factors in the SBT may be required to better differentiate among patients.

Prevalence of Work-Related Musculoskeletal Disorders in Iranian Physical Therapists: A Cross-sectional Study.

OBJECTIVE: The purpose of this study was to determine the prevalence of musculoskeletal disorders among Iranian physical therapists. METHODS: A cross-sectional study was carried out. An online survey was completed by Iranian physiotherapists from June 2017 to August 2017. A total of 333 online questionnaires were sent, and 319 questionnaires were fully completed and used for data analysis. The Persian version of the Nordic Questionnaire was the main outcome measurement. This questionnaire identified work-related pain or discomfort in 9 parts of the body, including: (1) neck, (2) shoulder, (3) elbow, (4) wrists, (5) upper back, (6) lumbar, (7) thighs, (8) knee, and (9) ankle. RESULTS: The findings of this study showed the prevalence of musculoskeletal disorders was 94% in Iranian physiotherapists. Lumbar (65%), neck (57.4%), shoulder (50.2%), upper back (49%), and knee (45.5%) were the most prevalent regions of these disorders. While ankle (19.7%) and elbow (21.6%) disorders showed the lowest prevalence. CONCLUSION: The prevalence of work-related musculoskeletal disorders was high in Iranian physiotherapists, especially in the lumbar, neck, shoulder, and upper back regions.

Relationships between muscular impairments, pain, and disability in patients with chronic nonspecific low back pain: a cross sectional study.

To clarify the significance of mechanical impairments, pain, and functional limitations as predictors of chronic low back pain (LBP). Ninety patients with chronic nonspecific low back pain (CNSLBP) were prospectively studied with clinical tests and questionnaires. Changes in muscle extensibility and endurance tests were evaluated and changes assessed in LBP intensity on numeric rating scale 0-10 and severity with Oswestry Disability Index (ODI) 0-100. In the present study we found significant associations between the 4 muscle extensibility and 2 endurance tests and pain at nonspecific patients with chronic LBP (P<0.005). The 2 muscle extensibility and 1 endurance tests were in complete equilibrium with ODI disability and hence showed similar results (P<0.005). The associations between the muscle extensibility and endurance tests and pain were significantly elevated in patients with nonspecific chronic LBP.

Psychometric Properties of the Persian Version of Care Dependency Scale in Nursing Homes.

PURPOSE: The purpose of the study was to examine the psychometric properties of the Persian version of the Care Dependency Scale (CDS) in nursing homes. DESIGN: Instrument development. METHODS: The English version of the CDS was translated into Persian. A convenience sample of 140 (100 older people without dementia and 40 patients with dementia) Persian-speaking people were selected from the nursing homes in Ahvaz, Iran. Cronbach's alpha, discriminant validity, and construct validity (exploratory factor analysis) were examined. FINDINGS: Exploratory factor analysis indicated that the CDS has two factors, including psychosocial and somatic factors. Discriminant validity showed that the CDS can differentiate patients with dementia from the older adults without dementia. CONCLUSIONS: The results of the study showed that the Persian CDS is a reliable and valid scale when used in nursing homes. CLINICAL RELEVANCE: The Persian version of the CDS can help clinicians and nurses to assess patients' need and the degree of care dependency among older adults in Persian-speaking areas.

Kinetic factors of vertical jumping for heading a ball in flexible flatfooted amateur soccer players with and without insole adoption.

BACKGROUND: According to literature, little is known regarding the effects of orthotic management of flatfoot on kinetics of vertical jump. OBJECTIVES: To compare the kinetic and temporal events of two-legged vertical jumping take-off from a force plate for heading a ball in normal and flexible flatfoot subjects with and without insole. STUDY DESIGN: A functional based interventional controlled study. METHODS: Random sampling method was employed to draw a control group of 15 normal foot subjects to a group of 15 flatfoot subjects. A force platform was used to record kinetics of two-legged vertical jump shots. RESULTS: Results indicate that insole did not lead to a significant effect on kinetics regarding anterior-posterior and mediolateral directions (p > 0.05). Results of kinetics related to vertical direction for maximum force due to take-off and stance duration revealed significant differences between the normal and flexible flatfoot subjects without insole (p < 0.05) and no significant differences between the normal foot and flexible flatfoot subjects with insole adoption (p > 0.05). CONCLUSIONS: These results suggest that the use of an insole in the flexible flatfoot subjects led to improved stance time and decrease of magnitude of kinetics regarding vertical direction at take-off as the main feature of two-legged vertical jumping function. CLINICAL RELEVANCE: Adoption of the insole improved the design of the shoe-foot interface support for the flexible flatfoot athletes, enabling them to develop more effective take-off kinetics for vertical jumping in terms of ground reaction force and stance duration similar to that of normal foot subjects without insole.

Comparison of the Effect of 8 weeks Aerobic and Yoga Training on Ambulatory Function, Fatigue and Mood Status in MS Patients.

BACKGROUND: Multiple Sclerosis (MS) is a disease of the central nervous system that results in many symptoms including mobility limitation and fatigue. PATIENTS AND METHODS: Thirty-one MS patients, all female with mean of age of 36.75 years and Expanded Disability Status Scale scores (EDSS) of 1.0 to 4.0 were recruited. Subjects were randomly assigned to one of the three groups: treadmill training, yoga or control groups. Treadmill training and yoga practice consisted of 8 weeks (24 sessions, thrice weekly). The control group followed their own routine treatment program. Balance, speed and endurance of walking, fatigue, depression and anxiety were measured by Berg Balance scores, time for 10m walk and distance for a two minute walk, Fatigue Severity Scale (FFS), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI), respectively. RESULTS: Comparison of results have shown that pre- and post-interventions produced significant improvements in the balance score, walking endurance, FFS score, BDI score and BAI score in the treadmill training group and yoga group. However, 10m walk time decreased in the treadmill training group but did not show any clear change in the yoga group. Moreover, the analysis showed significant differences between the treadmill training group and yoga group for BAI score. CONCLUSIONS: These results suggest that treadmill training and yoga practice improved ambulatory function, fatigue and mood status in the individuals with mild to moderate MS.

Reliability and validity of the Tegner and Marx activity rating scales in Iranian patients with anterior cruciate ligament injury.

PURPOSE: The aims of this study were to culturally translate and validate the Persian version of Tegner and Marx activity rating scales and to investigate their psychometric properties in a sample of patients (n = 100) with anterior cruciate ligament (ACL) injury. METHOD: Four questionnaires were completed by the respondents: Tegner and Marx activity scales, Knee injury and Osteoarthritis Outcome Score (KOOS) and Short-Form 12 Health Survey (SF-12). The Tegner and Marx were re-administered to 45 patients in the retest session, with time interval of 2-6 days between the two sessions. Test-retest reliability and internal consistency were assessed using intra-class correlation coefficient (ICC) and Cronbach's alpha, respectively. To evaluate construct validity of Tegner and Marx compared to similar and dissimilar concepts of KOOS and SF-12, the Spearman's rank correlation was used. RESULTS: Both Tegner and Marx activity scales have a high ICC level. The minimum Cronbach's alpha level of 0.70 was exceeded by Marx scale. In terms of construct validity, most of a priori hypotheses were confirmed. CONCLUSIONS: The Persian version of Tegner and Marx seems to be suitable for Iranian patients with ACL injury. Future studies are needed to investigate the psychometric properties of these questionnaires for Iranian patients with different knee problems.