Tran slation , cultural adap tation an d psycho metric anal ysis of U rd u ver sion of Vic torian; institu te of sp or ts ass es sme nt: Achill es quest i onnaire fo r athletes with achilles tendinopathy.

OBJECTIVE: To translate, culturally adapt and psychometrically analyse the Urdu version of the Victorian Institute of Spor t Assessment-Achilles questionnaire. METHODS: The cross-sec tional study was conducted at the Pak istan Sports Board, Lahore, Pakistan, from June 17, 2021, to February 15, 2022, and comprised patients with Achilles tendinopathy in group A and healthy controls in group B. Beaton's guidelines for cultural adaptation and validation for self-repor ted measures were followed to translate and validate the Victorian Institute of Sport Assessment-Achilles questionnaire in Urdu language. Data was analysed using SPSS 23. RESULTS: Of the 180 subjects with mean age 28.06±5.95 years, 125(69.6%) were males. There were 130(72.2%) patients in group A and 50(27.8%) controls in group B. The overall mean score of the Victorian Institute of Sport Assessment- Achille s questionnaire was 55.99±25.43; group A 41.14±9.54 and group B 94.60±4.22. The Urdu version exhibited excellent internal consistency with Cronbach's alpha values 0.95, and excellent test-retest reliability (p<0.001). Absolute reliability was expressed by standard error of measurement 5.317 and minimal detectable change (6.38). Convergent validity demonstrated strong correlation with the physical domain (r=0.81) of the Urdu version of the World Health Organisation Quality of Life Brief Version. CONCLUSIONS: The Victorian Institute of Sport Assessment-Achilles questionnaire could be utilised for assessing severity of Achilles tendinopathy among Urdu-speaking population for clinical as well as research purposes.

Clinical application of low-level laser therapy (Photo-biomodulation therapy) in the management of breast cancer-related lymphedema: a systematic review.

BACKGROUND: Breast cancer-related lymphedema (BCRL) is a frequent issue that arises after mastectomy surgery in women and compromises physical and mental function. Previously published studies have shown positive effects with the use of Low-level laser therapy in another term Photo-biomodulation therapy (PBM). This research investigated the efficacy of clinical use of LLLT (PBM) in the treatment of metastatic breast cancer-related lymphedema. METHODS: PubMed, PEDro, Medline, and the Cochrane Library were searched for LLLT clinical trials published before October 2021. The methodological quality of randomized trials and the effectiveness of Laser Therapy for BCRL were evaluated. The primary objectives were arm circumference or arm volume, whereas the secondary goals were to assess shoulder mobility and pain severity. RESULTS: Eight clinical trials were analyzed in total. Typically, the included RCTs had good research quality. At four weeks, there was a considerable reduction in arm circumference/volume, and this continued with long-term follow-up. However, no statistically significant change in shoulder mobility or pain severity was seen between the laser and placebo groups at 0-, 1-, 2-, and 3-month short-term follow-up. CONCLUSIONS: The findings of this comprehensive study demonstrated that LLLT (PBM) was successful in diminishing arm circumference and volume than improving shoulder mobility and pain. Data indicates that laser therapy (PBM) may be a beneficial treatment option for females with PML. Because of the scarcity of evidence, there is a strong need for well-conducted and longer-duration trials in this field. TRIAL REGISTRATION: Details of the protocol for this systematic review were registered on PROSPERO and can be accessed at www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42022315076 .

Role of low-intensity pulsed ultrasound on lumbar spondylolysis: A systematic review.

OBJECTIVE: To systematically review the role of low-intensity pulsed ultrasound on lumbar spondylolysis. METHODS: Literature search was conducted on PubMed, Embase, CINAHL, Web of Science, PEDro and Scopus databases to identify relevant studies published between 2010 and 2020 by using medical subject headings and applying Booleans, such as low-intensity pulsed ultrasound OR interventional ultrasound AND lumbar spine OR lumbar region AND spondylolysis OR stress fracture. Unpublished studies were hand-searched in the journals, abstracts of conferences were reviewed, and citation index was used for searching experts in the field and then contacting them for information. Studies included were the ones that had at least one of the following outcomes: bone union rate, treatment period to bone union and time to return to previous activities. RESULTS: Of the 243 studies identified, 228(94%) were full text articles and only 2(0.8%) studies were critically appraised for qualitative synthesis based on bone union rate, treatment period to bone union, and time to return to previous activities. CONCLUSIONS: Low-intensity pulsed ultrasound was found to be effective for bone union and a useful therapy for quick return to playing sports in patients with lumbar spondylolysis.

Translation, cross-cultural adaptation and psychometric properties of the Urdu version of knee injury and osteoarthritis outcome score questionnaire for Pakistani population.

BACKGROUND: Knee injury and osteoarthritis outcome score questionnaire is a widely used tool for measuring short and long-term patient-relevant outcomes following knee injury. KOOS is neither translated nor examined for psychometric properties before. Therefore, the aim of this study was to translate, culturally adapt and check the psychometric properties of the KOOS in Urdu. METHODOLOGY: The translation and cultural adaptation was performed according to pre-defined guidelines. A total of 117 participants (54 males and 63 females) were recruited. The study had two steps: 1) Translation and cultural adaptation 2) Reliability and validity testing. The reliability (test-retest and internal consistency at (95% confidence interval) as well as the validity (Convergent validity) of final Urdu version of KOOS was tested. RESULTS: For all five domains, the KOOS Urdu version (KOOS-U) has demonstrated high test-retest reliability ICC = 0.90-0.96(CI = 95%). For all domains, the internal consistency was determined to be excellent (α = 0.82-0.96). There were no floor or ceiling impacts noted. Convergent validity was found to be good, as measured by Pearson's correlation coefficient. The findings revealed a strong negative association between the KOOS-U (QOL and pain) and the NPRS. And there was a low to high positive correlation between five KOOS-U domains and all SF-12 domains, i.e., there was a significant positive correlation between the pain domains of both KOOS and SF-12 with the r = 0.87(p < 0.05). CONCLUSION: The Urdu version of KOOS is a valid, reliable, and responsive instrument to assess functional disability of patients with Knee Osteoarthritis with excellent psychometric properties.

Reliability of Hand-Held Dynamometer for assessing Isometric Lumbar Muscles Strength in Asymptomatic Healthy Population.

OBJECTIVE: To determine intra-rater and inter-rater reliability of hand-held dynamometer for assessing isometric lumbar muscle strength in asymptomatic healthy population. METHODS: It was a cross-sectional study conducted at the department of physiotherapy, University of Lahore Teaching Hospital, Lahore, Pakistan, from July 2020 to August 2020 through non probability-purposive sampling technique. Thirty healthy subjects were tested at thirty-degree lumbar flexion and zero-degree lumbar extension positions. Two raters assessed isometric strength of lumbar flexor and extensor muscles, by a hand-held dynamometer. Strength was measured and recorded by each of the two raters and re-assessed after a week. Correlation and pairwise comparison were done between readings. ICC values were calculated for the assessment of isometric lumbar muscle strength using handheld dynamometer. RESULTS: A total of 30 healthy subjects had participated with mean age of 22.84±1.21 years, height 174.33±6.83 cm, weight 68.58±5.08 kg and BMI 22.52±0.35. Findings showed an excellent intra-rater (ICC 2, k = 0.95 to 0.97) and inter-rater (ICC 2, k = 0.94 to 0.95) reliability. CONCLUSIONS: Hand held dynamometer demonstrated an excellent intra- and inter-rater reliability for assessment of isometric lumbar muscles strength of healthy subject at clinical setting as it is simple to use, portable and cost-effective for the precise measurement of lumbar muscles strength.

Comparative effect of driving side on low back pain due to Repetitive Ipsilateral Rotation.

OBJECTIVE: To determine the effects of repetitive ipsilateral rotation on low back pain among the taxi drivers of right and left hand drive. METHODS: A total of 1200 (600 Iran+600 Pakistan) male taxi drivers, aged between 20-60 years with work experience of more than one year were randomly selected and interviewed in Tehran (Iran) & Lahore (Pakistan) to fill self-administered questionnaires in Persian and Urdu languages which contained socio-demographic, work related and LBP characteristics. Chi-square test and multiple logistic regression models were employed for statistical analyses. RESULTS: Point, one week, one year and lifetime prevalence of LBP among right hand drive taxi drivers was 26.7%, 35.5%, 49.8% and 77.7% respectively. Point, one week, one year and lifetime prevalence of LBP among left hand drive taxi drivers was 37%, 42.7%, 53.5% and 72.3% respectively. Mean Numeric Pain rating scale (NPRS) score was 4.15 (SD=1.42) in Pakistan, while in Iran it was 4(SD=1.57). There was no significant difference regarding pain intensity (p=0.123) between drivers from both countries. Mean Roland-Morris Questionnaire (RMQ) score among drivers in Pakistan with LBP was 7.76(SD= 2.50), while in Iranian drivers who had LBP, mean RMQ score was 7.71(SD=2.99). CONCLUSION: Static or less dynamic muscles are more prone to LBP due to lower endurance. Lack of exercising habit, work as a driver for more number of years, driving within city, more driving hours in a day, forward bending, lifting, no seat comfort, lack of awareness regarding ergonomics and lower satisfaction level of job were the main reasons of LBP.

Translation, cross-cultural adaptation and psychometric properties of the Urdu version of the avoidance endurance behavior questionnaire in patients with chronic musculoskeletal pain.

BACKGROUND: The Avoidance Endurance Questionnaire (AEQ) successfully measures the fear-avoidance and endurance-related responses to chronic pain. OBJECTIVE: The objective of this study was to translate, cross-culturally adapt AEQ into Urdu and assess the reliability and validity of the Urdu version. METHOD: For the translation and cross-cultural adaptation process, the Beaton Guidelines were followed. A total of 103 participants responded to the Urdu version of the AEQ SF-12, Pain Catastrophizing Scale (PCS) and Numeric Pain Rating Scale (NPRS) at baseline and after 48 hours. The test-retest reliability was assessed using the intraclass correlation coefficient (ICC). Cronbach's alpha was used to measure internal consistency. To measure validity, Pearson's correlation between the subscales of AEQ-Urdu and other outcome measures (SF-12, PCS and NPRS scores) were used (p< 0.05). RESULTS: The mean age of the total 103 participants was 32.7 ± 10.90 among which 45 (43.6%) were male and 58 (56.3%) were female. The pre-final version of the translated AEQ was tested on 40 Urdu speaking participants and no major changes were made. The Cronbach's alpha for all subscales of the AEQ-Urdu ranged from 0.848-0.990. AEQ-U showed an excellent test-retest reliability with the ICC ranging from 0.775-0.996. The majority of the subscales of AEQ showed significant (p< 0.05) positive correlation with pain scales (PCS and NPRS) and negative correlation with the domains of SF-12. CONCLUSION: The AEQ-U has reliable and valid construct validity, good internal consistency, and test-retest reliability, indicating that it has adequate psychometric features and can be a useful tool for evaluating pain responses in patients with chronic musculoskeletal pain.

Comparison of the Conjunct Effects of Electrical Stimulation and Whole-Body Vibration Therapy with Transcranial Direct Current Stimulation and Whole-body Vibration Therapy on Balance and Function in Children With Spastic Cerebral Palsy.

BACKGROUND AND OBJECTIVES: Cerebral palsy is a neurodevelopmental condition that results in impaired movement and posture, often accompanied by disturbances in balance and functional abilities. Recent advances in neurorehabilitation, including whole-body vibration therapy (WBVT), functional electrical stimulation, and transcranial direct current stimulation, show promise in enhancing traditional interventions and fostering neuroplasticity. However, the efficacy of their conjunct effects remains largely uncharted territory and warrants further exploration. The objective of the study was to compare the conjunct effects of functional electrical stimulation (FES) and WBVT with transcranial direct current stimulation (tDCS) and WBVT on lower extremity range of motion (ROM), dynamic balance, functional mobility, isometric muscle strength and hand grip strength in children with spastic cerebral palsy. METHODS: A randomized clinical trial was carried out on 42 children of both genders with spastic cerebral palsy, aged 5-15 years. The children were divided at random into three groups (14 in each group). In Group A, there were three (21.42%) males and 11 (78.57%) females, in Group B, eight (57.14%) were males and six (42.85%) were females, and in Group C, six (42.85%) children were males and eight (57.14%) were females. Group A received WBVT only, Group B received WBVT and FES, and Group C received WBVT and tDCS. The intervention was applied four times a week for four consecutive weeks. The data was collected two times before and immediately after four weeks of intervention. Lower extremity ROM was measured by a goniometer, functional mobility or dynamic balance was measured by a Time Up and Go test, isometric muscle strength was measured by a digital force gauge, and hand grip strength was assessed by a digital hand-held dynamometer. IBM SPSS Statistics for Windows, Version 27.0 (Released 2020; IBM Corp., Armonk, New York, United States) was utilized for statistical analysis. RESULTS: The mean age of the children in groups A, B, and C was 12.21±2.11 years, 11.71±2.01, and 11.07±2.01 years respectively. Intergroup analysis revealed a statistically significant difference (p<0.05) in the lower extremity range of motion, and functional mobility. Hand grip strength and isometric muscle strength between three groups. Post hoc analysis revealed that WBVT with transcranial direct current stimulation combined showed the most improvement. CONCLUSION: The study concluded that positive effects were seen in all three groups but tDCS with WBVT was found to be most effective in improving lower extremity ROM, functional mobility or dynamic balance, isometric muscle strength, and hand grip strength in children with spastic CP. The differences between the groups were statistically significant. The effect size was substantial enough to surpass established clinical benchmarks, indicating that the observed improvements are likely to have meaningful and beneficial impacts on patient outcomes.

Translation and validation of urdu version short form-mcgill pain questionnaire-2.

BACKGROUND: Low back pain is one of the most common complaints affecting many individuals. The McGill Pain Questionnaire is used in various clinical settings to assess different types of pain and one of the most extensively used outcomes measures for pain in the world. The purpose of this study was to translate and validate the original English version of the SF-MPQ-2 into Urdu (SF-MPQ-2-U). METHODS: For this study, Mapi Research Trust protocols were followed for the forward and backward translation. Test-retest reliability was used to assess the reliability. Cronbach's alpha and Omega was used to determine internal consistency. Pearson's correlation was used to evaluate convergent validity. Confirmatory factor analysis was also conducted. RESULTS: The Cronbach's alpha for SF-MPQ-2-U was 0.73 to 0.79, indicating acceptable internal consistency. Omega score for the SF-MPQ-U were 0.918. The ICC varied from 0.799 to 0.878 for domains of SF-MPQ-2-U. The CFA of the SF-MPQ-2-U met model fit indices with GFI and NFI > 0.90. The inter-scale correlation between baseline and re-test data was from 0.63 to 0.71, indicating a positive and strong correlation. The SF-MPQ-2-U and ODI-U had a baseline correlation of 0.547. The correlation of SF-MPQ-2-U & VAS at baseline data was 0.558. Pearson's correlation between subscales was r = 0.253 with p 0.01, which was statistically significant. CONCLUSION: The SF-MPQ-2-U is considered to have good convergent validity at inter scale and between two scale levels. Reliability was checked by test-retest reliability, Internal consistency was checked using Cronbach's alpha and Omega that showed good internal consistency for measuring different types of pain in patients with low back pain who speak Urdu. To make the questionnaire more valid and reliable, it is recommended for the researchers to do in-depth research on larger sample size.

A shear-wave sonoelastography investigation of calf muscle pump biomechanics in patients with chronic venous disease and healthy controls.

BACKGROUND: chronic venous disease (CVD) is a common progressive disorder with incompetence of calf muscle pump due to weakness and ankle mobility abnormality is an important etiological factor in CVD, but the biomechanical properties of calf muscle pump are remain unknown. OBJECTIVES: The purpose of the present study was to evaluate group differences between the biomechanical properties changes of the medial gastrocnemius muscle (GM) and its fascias in participants with CVD and healthy controls. METHODS: In this case-control study, thirty patients with CVD in three equal groups (mild: C1 - C2, moderate: C3 - C4, severe: C5 - C6) and 20 healthy subjects in a control group participated. The medial GM and its fascias shear modulus (stiffness) were measured using a shear-wave sonoelastography in rest and active dorsiflexion positions of ankle joint. RESULTS: The results of variance (ANOVA) analysis showed a significant difference in shear wave elastography (SWE) value between the groups for medial GM and its fascias at rest and active dorsiflexion of the ankle joint (P < 0.05). There was a statistically significant increase in SWE value of the medial GM and its fascias in moderate (c3-c4) and severe CVD groups (C5-C6) compared to the control and mild (C1-C2) CVD groups. A positive correlation was discovered between disease grades and the medial GM and its fascias SWE in patients with CVD ranging between r = 0.846 to 0.891; P < 0.001. CONCLUSION: An alteration stiffness in calf myofascial pump as compared to control group indicated an impaired myofascial biomechanics. Calf myofascial SWE may be valuable information in the diagnosis and follow-up processes of patients with CVD.

Effects of low-intensity pulsed ultrasound on pain and functional disability in patients with early-stage lumbar spondylolysis: A randomized controlled trial.

BACKGROUND: Low Intensity Pulsed Ultrasound (LIPUS) is beneficial in accelerating fracture recovery, enhancing their capacity to execute tasks of daily life and, as a result, their autonomy. OBJECTIVE: To compare the outcomes of routine physical therapy and routine physical therapy along with LIPUS in patients with early-stage lumbar spondylolysis. METHODS: Thirty-four (29 males and 5 females) patients exhibiting symptomatic low back pain for at least four weeks were recruited and randomly divided into control group (CG) and intervention group (IG) group. Randomization was done by using goldfish bowl method and allocation was done by using sealed envelope method. Parallel assignment was done. Numeric Pain Rating Scale (NPRS) was utilized for the measurement of pain and Oswestry Disability Index (ODI) for functional disability. Patients were assessed at baseline, at the end of 12th and 20th week. Interventions were applied by two physical therapists (one male and one female) having more than eight years of clinical experience for 10 weeks on alternate days. RESULTS: Intervention group reported significant percentage change of 47% at 12th week and 65% at 20th week for pain and 42% at 12th week and 81% at 20th week for functional disability compared with 40% at 12th week and 37% at 20th week for pain and 3% at 12th week and 25% at 20th week follow-up for functional disability from baseline in control group. CONCLUSION: Low-intensity pulsed ultrasound has significantly reduced pain and functional disability in patients with early-stage lumbar spondylolysis by using following parameters; 1.1-MHz oscillation frequency, 1-kHz pulsed frequency, 100-mW/cm2 spatial intensity, 2 ms pulse duration, 100Hz pulse repetition rate, 20% pulse duty cycle, and 20-min duration on alternate days.

The Effect of Unihemispheric Concurrent Dual-Site Transcranial Direct Current Stimulation of Primary Motor and Dorsolateral Prefrontal Cortices on Motor Function in Patients With Sub-Acute Stroke.

It is believed that unihemispheric concurrent dual-site transcranial direct current stimulation (tDCSUHCDS) of the primary motor cortex (M1) and the dorsolateral prefrontal cortex (DLPFC) causes an increase in motor cortex excitability. However, the clinical effect of this type of stimulation on patients with neurological conditions is not yet known. The aim of the present study was to assess the effect of anodal-tDCSUHCDS (a-tDCSUHCDS) on upper limb motor function in subacute stroke patients. Fifteen patients participated in this sham-controlled crossover study. The main outcome measures were the reaction time (RT) to visual stimuli, completion time of a nine-pin pegboard (9-PPB), and the scores from the Fugl-Meyer assessment (FMA) for the upper limb of the involved side before and after three brain stimulation conditions. For a-tDCSUHCDS, the anodal electrodes were placed on the M1 and the DLPFC, while for a-tDCS, the anodal electrode was placed on the M1. For the sham stimulation, the tDCS was turned off after 30 s. For brain stimulation, the selected current was 1 mA for 20 min. After a-tDCSUHCDS, there was a significant reduction in the RT and completion time of the 9-PPB compared with the times after a-tDCS and the sham stimulation: p = 0.013 and p = 0.022, respectively). However, there was no significant difference in the FMA scores after the three types of stimulations (p = 0.085). Compared with a-tDCS, a-tDCSUHCDS temporarily improved the RT and dexterity of the involved hand in subacute stroke patients. Clinical Trial Registration: Iranian Registry of Clinical Trials (IRCT), identifier IRCT2015012520787N1.

Investigating the anticipatory postural adjustment phase of gait initiation in different directions in chronic ankle instability patients.

OBJECTIVE: The main objective of the present study was to analyze how supra spinal motor control mechanisms are altered in different directions during anticipatory postural phase of gait initiation in chronic ankle instability patients. It seems that supra spinal pathways modulate anticipatory postural adjustment phase of gait initiation. Yet, there is a dearth of research on the effect of chronic ankle instability on the anticipatory postural adjustment phase of gait initiation in different directions. METHOD: A total of 20 chronic ankle instability participants and 20 healthy individuals initiated gait on a force plate in forward, 30° lateral, and 30° medial directions. RESULTS: According to the results of the present study, the peak lateral center of pressure shift decreased in forward direction compared to that in other directions in both groups. Also, it was found that the peak lateral center of pressure shift and the vertical center of mass velocity decreased significantly in chronic ankle instability patients, as compared with those of the healthy individuals. CONCLUSION: According to the results of the present study, it seems that chronic ankle instability patients modulate the anticipatory postural adjustment phase of gait initiation, compared with healthy control group, in order to maintain postural stability. These changes were observed in different directions, too.

Factors Associated With Domestic Violence Against Women in Iran: An Exploratory Multicenter Community-Based Study.

Domestic violence against women committed by intimate partners is a worldwide concern especially in developing countries. The aim of this study was to assess the problem among Iranian women and identify associated risk factors. Using a cross-sectional multicenter design, 1,600 women in six different areas of Iran were surveyed. A measure of domestic violence against women was administered and demographic information collected. Logistic regression models were used to identify factors associated with domestic violence. The prevalence of domestic violence among participants were emotional (64%), physical (28%), and sexual (18%). Higher education (both women and their partners), employment status of partner (being employed), and lower number of children lowered the risk, whereas history of previous marriage (for either women or their partners), unstable marriage, substance abuse, crowded family situation, and lower socioeconomic status increased the risk of domestic violence. There is a high prevalence of domestic violence, particularly emotional, against women by their partners. Preventive measures are recommended such as increasing public awareness, improving in socioeconomic status of families, educating women about what they can do, and encouraging counseling for the couple or the woman alone.