Behnam Akhbari

Knee injury and Osteoarthritis Outcome Score (KOOS); reliability and validity in competitive athletes after anterior cruciate ligament reconstruction.

OBJECTIVE To validate the Knee injury and Osteoarthritis Outcome Score (KOOS) for the assessment of competitive athletes with higher level sports activities after anterior cruciate ligament (ACL) reconstruction. METHODS AND MEASURES Fifty-seven athletes (39 males and 18 females; age, 25.6 ± 3.4 years; height, 179.6 ± 7.4 cm; weight, 77.6 ± 9.8 kg) after ACL reconstruction were asked to complete the Persian KOOS and Short Form-36 (SF-36) questionnaires in the test session. To evaluate test-retest reliability, all participants filled out the KOOS and SF-36, 6-8 days after the first visit. The properties of the KOOS in terms of reliability [Intraclass Correlation Coefficient (ICC)], internal consistency (Cronbachs alpha), dimensionality (item-scale correlation) and construct validity (Spearmans rank correlation) were evaluated. RESULTS No floor or ceiling effect was observed. The ICCs (S.E.M.s) of the KOOS subscales were: Pain 0.93 (2.2), Symptoms 0.85 (3.1), Activities of Daily Living 0.91 (2.9), Function in Sport and Recreation 0.75 (2.1) and Knee-related Quality of Life 0.89 (2.6). The Cronbachs alphas of the KOOS subscales were: Pain 0.91, Symptoms 0.75, Activities of Daily Living 0.96, Function in Sport and Recreation 0.86 and Knee-related Quality of Life 0.74. Spearmans rank correlations between the subscales of the KOOS and representative subscales of the SF-36 ranged from 0.40 to 0.79. CONCLUSION This study illustrates the validity and reliability of the KOOS in measuring the functional status and quality of life of athletes after ACL reconstruction. This study further validates the use of the KOOS in highly competitive athletes in research on knee injuries.

Intrasession and intersession reliability of postural control in participants with and without nonspecific low back pain using the Biodex Balance System.

OBJECTIVE The purpose of this study was to evaluate the reliability of the Biodex Balance System (BBS) (Biodex Medical Systems, Shirley, NY) in chronic low back pain (CLBP) patients and healthy individuals in various conditions of postural and cognitive difficulty. METHODS In this methodological study, using the BBS, dynamic balance of 15 CLBP patients and 15 healthy matched individuals was assessed during bilateral stance in combined conditions of visual feedback (eyes open and eyes closed) and platform stability (levels 5 and 3), either isolated or concurrent with performing cognitive task (auditory Stroop task). The Overall stability index, anterior-posterior stability index, and medial-lateral stability index, provided by BBS as measures of postural performance, were recorded. Intraclass correlation coefficient (ICC), standard error of measurement, and coefficient of variation were used to determine intersession and intrasession reliability of postural and cognitive measures. RESULTS Biodex Balance System stability indices were more reliable in the CLBP (compared with healthy) group. The intersession ICCs in CLBP group for anterior-posterior stability index ranged from 0.60 to 0.88, for medial-lateral stability index from 0.64 to 0.94, and for OASI from 0.63 to 0.91. The intersession ICCs in healthy group for anterior-posterior stability index ranged from 0.42 to 0.86, for medial-lateral stability index from 0.56 to 0.89, and for OASI from 0.54 to 0.84. Biodex Balance System stability indices were more reliable in eyes-closed (compared with eyes-open) condition and platform stability level 5 (compared with level 3). CONCLUSION Biodex Balance System stability indices appear to be reliable measures of postural control in the CLBP patients especially in more challenging conditions, such as when standing with eyes closed.

Comparison of functional outcome measures after ACL reconstruction in competitive soccer players: a randomized trial.

BACKGROUND The choice of graft for anterior cruciate ligament (ACL) reconstruction remains controversial. Although many outcome studies comparing bone-patellar tendon-bone and semitendinosus and gracilis tendon grafts have been performed, most have not included tests of functional outcomes that challenge the graft. The objective of the current study was to compare the functional performances of soccer players after ACL reconstruction that was performed with either a bone-patellar tendon-bone or a semitendinosus and gracilis tendon graft. METHODS Forty-two soccer players with unilateral ACL injury were prospectively randomized to a bone-patellar tendon-bone group (BPTB group; twenty-one subjects) or a semitendinosus and gracilis tendon group (STG group; twenty-one subjects) and followed a rehabilitation protocol. At the time of return to sports, the patients were asked to execute strength, hop, and jump tests and the results were compared between the groups. Twenty-one healthy athletes were recruited as the control group to evaluate their performance of the same tests. RESULTS The limbs with the ACL reconstruction in the STG group had greater values for quadriceps torque as well as on the triple-hop, crossover-hop, and jump-landing test (p < 0.01), but the STG and BPTB groups showed similar results in terms of hamstrings peak torque and the results of two other hop tests (p > 0.05). Moreover, the subjects with ACL reconstruction had significantly lower values with regard to quadriceps and hamstrings peak torques and the results of the hop and jump tests compared with the healthy athletes (p < 0.01). CONCLUSIONS At the time of return to sports, the STG group had better performance in terms of quadriceps strength and the results of the triple-hop, crossover-hop, and jump-landing tests compared with the BPTB group. Compared with controls, soccer players who had undergone ACL reconstruction had less quadriceps and hamstrings strength and inferior hop performance and jump-landing strategy.

Cross-cultural validation of the Falls Efficacy Scale International (FES-I) using self-report and interview-based questionnaires among Persian-speaking elderly adults

FES-I has been designed to assess fear of falling (FoF). The purpose of this study was to establish the Persian-language version of the FES-I and to assess its psychometric properties under different modes of administration: self-report and interview-based. Participants included 191 elderly people aged over 60 who were mostly community dwelling. With an interval of 14 days, 97 volunteers completed the questionnaire in the retest session. To evaluate the construct validity, we assessed the ability of the FES-I to discriminate people based on gender, level of education, number of falls and FoF. The correlation with the Short Form of Health Survey (SF-36), Timed Up and Go (TUG) and Functional Reach Test (FRT) was also determined to test validity. Internal consistency was excellent in both self-report (0.93) and interview (0.92) versions. All intra-class correlations (ICCs) were above 0.70 with the highest reliability obtained for the condition where the interview based FES-I was used in both test and retest sessions. The strength of correlation between the FES-I and TUG varied based on mode of administration: moderate for interview and high for self-report mode. The FES-I had a higher correlation with the SF-36 subscales of physical health than subscales of mental health. The FES-I had the ability to discriminate the participants based on gender, educational level, and number of falls and FoF. In conclusion, both interview and self-report versions of the FES-I demonstrated acceptable measurement properties to assess FoF in Iranian elderly persons.

Effect of Dual-Tasking on Dynamic Postural Control in Individuals With and Without Nonspecific Low Back Pain

OBJECTIVE The purpose of this study was to compare the effect of dual tasking on postural and cognitive performance between participants with and without nonspecific chronic low back pain. METHODS In this 3-factor mixed-design study, dynamic postural stability was assessed in 15 patients with chronic nonspecific low back pain and 15 age-, sex-, and size-matched asymptomatic participants. Bilateral stance on a Biodex Balance System was investigated at 3 levels of postural task difficulty (different platform stabilities levels with eyes open and closed) and 2 levels of cognitive task difficulty (with or without auditory Stroop test). We measured anterior-posterior, medial-lateral, and overall indices for postural performance. Average reaction time and error ratio of a modified auditory Stroop test were calculated as measures of the cognitive task performance. RESULTS Mixed-design 3-way analyses of variance revealed significant interactions. Post hoc 2-way analyses of variance showed significant group by cognitive task difficulty for anterior-posterior (P < .001), medial-lateral (P = .003), and overall stability indices (P < .001) on a stiffness level of 5 with eyes closed. At this level, there were significant differences between single- and dual-task conditions for anterior-posterior (P < .001), medial-lateral (P = .02), and overall stability indices (P < .001) only in the chronic low back pain group. Also, at the most difficult postural conditions, participants with chronic low back pain increased their error ratio (P = .002), whereas matched asymptomatic individuals increased their reaction time (P < .01) of the auditory Stroop test. CONCLUSION Postural task performance is attenuated by cognitive loading at a moderate level of postural task difficulty. Therefore, to observe the effect of attentional demands of postural control, task difficulty should be considered.

Dual-tasking effects on dynamic postural stability in athletes with and without anterior cruciate ligament reconstruction

PURPOSE To compare the effect of dual tasking on postural stability between patients with anterior cruciate ligament reconstruction (ACL-R) and healthy controls. METHODS Single-limb postural stability was assessed in 17 athletes with ACL-R and 17 healthy matched athletes while standing on a Biodex Balance System platform in 4 conditions: stability level of 8 (ie, more-stable support surface) with eyes open, stability level of 8 with eyes closed, stability level of 6 (ie, less-stable support surface) with eyes open, and stability level of 6 with eyes closed. Postural-stability tasks were performed with and without auditory Stroop task. The anteroposterior stability index (APSI), mediolateral stability index (MLSI), and overall stability index (OSI) as measures of postural performance, as well as reaction time and error ratio as measures of cognitive performance, were recorded. RESULTS Dual-tasking effect on postural stability was not significantly different between the groups in 3 postural conditions. Only in level 6 with eyes open, for APSI and OSI, patients with ACL-R showed lower postural stability under the dual-task condition. However, patients showed poorer performance on both reaction time and error ratio in all postural conditions. CONCLUSIONS The patients with ACL-R appeared to sacrifice their cognitive performance to optimize their performance on postural stability. This posture-first strategy was reflected by a more pronounced effect of dual tasking on the auditory Stroop task than the postural-stability task. In situations where maintenance of posture is challenging, giving priority to the postural task at the expense of cognitive performance can ensure safety from balance loss.

Effect of spinal stabilization exercise on dynamic postural control and visual dependency in subjects with chronic non-specific low back pain

BACKGROUND Motor control approach towards chronic non-specific low back pain (CNLBP) has gained increasing attention. CNLBP patients have shown to be more visually dependent for the postural control process than control subjects but no study has yet investigated the treatment programs effect on this disorder. METHODS Forty CNLBP patients volunteered to participate in this experimental study. The subjects were randomly assigned into either stabilization exercise (SE) or control group both receiving 12 sessions of routine physiotherapy for four weeks. The SE group also received intensive stabilization exercise. Balance (in terms of overall (OSI), anteroposterior (APSI) and mediolateral stability indices (MLSI)) and functional disability were assessed by Biodex Balance System(®) (BBS) and Oswestry Low Back Disability Questionnaire, respectively prior and after the interventions. The balance tests were performed with open and closed eyes. RESULTS Both interventions significantly decreased all stability indices but the SE group showed a more pronounced improvement in OSI and APSI. In the SE group, vision deprivation had smaller destabilizing effects on OSI and APSI as compared with the control group. The groups were not statistically different prior and after the interventions on all dependent variables. Oswestry index reduction in the SE group was more pronounced but the interaction of time and group variables were not significant on pain intensity. CONCLUSION Both interventions effectively enhanced stability indices and functional capabilities and reduced pain intensity in CNLBP patients. The SE protocol made the patients less visual dependent perhaps via better stability. Since pain reduction was not different between the groups, more functional improvement in SE group cannot simply be interpreted via the pain interference and might be related to postural control capabilities of the patients.

Intra- and Inter-session Reliability of Static and Dynamic Postural Control in Participants with and without Patellofemoral Pain Syndrome

PURPOSE To determine the intra- and inter-session reliability of balance performance in people with patellofemoral pain syndrome (PFPS) and matched controls. METHODS In this methodological study, single-leg-stance performance of 15 participants with unilateral PFPS and 15 healthy matched controls was assessed using the Biodex Balance System (BBS) under 4 task difficulty levels (static and dynamic, with and without visual feedback). Intra-class correlation coefficients (ICCs), standard errors of measurement, and coefficients of variation were calculated for the overall stability index, anterior-posterior stability index, and medial-lateral stability index. RESULTS Static and dynamic postural performance during single-leg stance showed moderate to very high reliability in the PFPS group (ICCs=0.53-0.96) and in healthy control participants (ICCs=0.51-0.91). Both measures were more reliable with eyes closed than with eyes open. CONCLUSION BBS stability indices appear to have acceptable reliability in people with PFPS, particularly in more challenging conditions, and may be incorporated into the evaluation and rehabilitation of this patient group.

Translation, cross-cultural adaptation and validation of the Persian version of COOP/WONCA charts in Persian-speaking Iranians with multiple sclerosis

Abstract Purpose: Translation, cross-culturally adaptation and validation of a Persian version of COOP/WONCA charts in Persian-speaking Iranians with multiple sclerosis (MS). Method: The Persian version of COOP/WONCA charts was developed after a standard forward translation, synthesis and backward translation. A total of 197 subjects with MS participated in this study. They were asked to complete the COOP/WONCA charts and Short-Form 36 Health Survey (SF-36). The COOP/WONCA charts were re-administered to 50 patients, 4 weeks after the first session. Expanded Disability Status Scale (EDSS) was also scored for each subject by the referring physician. Construct validity was assessed by testing linear relationship between corresponding domains of the COOP/WONCA charts, the SF-36 and the EDSS. Test–retest reliability was examined using interclass correlation coefficient (ICC), standard error of measurement (SEM) and minimal detectable change (MDC) values. Results: Related domains of COOP/WONCA charts and SF-36 demonstrated strong linear relationships with Spearman’s coefficients ranging from −0.51 to −0.75 (p< 0.05). Physical fitness and daily activity charts also demonstrated strong relationships with the EDSS by Spearman’s coefficients of 0.65 and 0.50, respectively (p< 0.05). The ICC values for most of COOP/WONCA charts domains were acceptable (>0.70) except for feelings and quality-of-life domains that were 0.50 and 0.51, respectively. Conclusions: The Persian version of the COOP/WONCA charts was shown to be psychometrically appropriate to evaluate the functional level and quality of life in Persian-speaking Iranians with MS. Implications for rehabilitation COOP/WONCA charts are now available in Persian and demonstrate good psychometric properties. COOP/WONCA charts demonstrate excellent reliability and construct validity in a Persian-speaking Iranian population with MS. Minimal detectable change in COOP/WONCA is now available in MS to guide within and between group analyses. Knowledge on a wide variety of physical, mental and emotional parameters as well as the status of patients’ symptoms, daily activities and quality of life helps rehabilitation clinicians and service providers plan preventive and remedial interventions more effectively.

Reliability of the Upper Trapezius Muscle and Fascia Thickness and Strain Ratio Measures by Ultrasonography and Sonoelastography in Participants With Myofascial Pain Syndrome

Objective: The purpose of this study was to assess the intra‐ and interexaminer reliability of the upper trapezius muscle and fascia thickness measured by ultrasonography imaging and strain ratio by sonoelastography in participants with myofascial pain syndrome. Methods: Thirty‐two upper trapezius muscles were assessed. Two examiners measured the upper trapezius thickness and strain ratio 3 times by ultrasonography and sonoelastography independently in the test session. The retest session was completed 6 to 8 days later. Results: A total of 87.5% of participants had trigger points on the right side, and 22.5% had trigger points on the left side. For the test session, the average upper trapezius thickness, fascia thickness, and strain ratio measured by first and second examiners were 11.86 mm and 11.56 mm, 1.23 mm and 1.25 mm, and 0.94 and 0.99, respectively. For the retest session, the previously mentioned parameters obtained by first and second examiners were 11.76 mm and 11.39 mm, 1.27 mm and 1.29 mm, and 0.96 and 0.99, respectively. The intraclass correlation coefficients indicated good to excellent reliability for both within‐intraexaminer (0.78‐0.96) and between‐intraexaminer (0.75‐0.98) measurements. Also, the intraclass correlation coefficients and standard errors of measurement of interexaminer reliability ranged between 0.88 to 0.93 and 0.05 to 0.44 for both muscle and fascia thickness and 0.70 to 0.75 and 0.04 to 0.20 for strain ratio of upper trapezius, respectively. Conclusion: Upper trapezius thickness measurements by ultrasonography and strain ratio by sonoelastography are reliable methods in participants with myofascial pain syndrome.