Ismail Ebrahimi Takamjani

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.

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

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

Reliability and validity of an iPhone® application for the measurement of lumbar spine flexion and extension range of motion

Background Measurement of lumbar spine range of motion (ROM) is often considered to be an essential component of lumbar spine physiotherapy and orthopedic assessment. The measurement can be carried out through various instruments such as inclinometers, goniometers, and etc. Recent smartphones have been equipped with accelerometers and magnetometers, which, through specific software applications (apps) can be used for inclinometric functions. Purpose The main purpose was to investigate the reliability and validity of an iPhone® app (TiltMeter© -advanced level and inclinometer) for measuring standing lumbar spine flexion–extension ROM in asymptomatic subjects. Design A cross-sectional study was carried out. Setting This study was conducted in a physiotherapy clinic located at School of Rehabilitation Sciences, Iran University of Medical Science and Health Services, Tehran, Iran. Subjects A convenience sample of 30 asymptomatic adults (15 males; 15 females; age range = 18–55 years) was recruited between August 2015 and December 2015. Methods Following a 2–minute warm-up, the subjects were asked to stand in a relaxed position and their skin was marked at the T12–L1 and S1–S2 spinal levels. From this position, they were asked to perform maximum lumbar flexion followed by maximum lumbar extension with their knees straight. Two blinded raters each used an inclinometer and the iPhone ® app to measure lumbar spine flexion–extension ROM. A third rater read the measured angles. To calculate total lumbar spine flexion–extension ROM, the measurement from S1–S2 was subtracted from T12–L1. The second (2 hours later) and third (48 hours later) sessions were carried out in the same manner as the first session. All of the measurements were conducted 3 times and the mean value of 3 repetitions for each measurement was used for analysis. Intraclass correlation coefficient (ICC) models (3, k) and (2, k) were used to determine the intra-rater and inter-rater reliability, respectively. The Pearson correlation coefficients were used to establish concurrent validity of the iPhone® app. Furthermore, minimum detectable change at the 95% confidence level (MDC95) was computed as 1.96 × standard error of measurement × \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{upgreek} \usepackage{mathrsfs} \setlength{\oddsidemargin}{-69pt} \begin{document} }{}

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

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Reliability and concurrent validity of a new iPhone® goniometric application for measuring active wrist range of motion: a cross‐sectional study in asymptomatic subjects

\end{document}2. Results Good to excellent intra-rater and inter-rater reliability were demonstrated for both the gravity-based inclinometer with ICC values of ≥0.84 and ≥0.77 and the iPhone® app with ICC values of ≥0.85 and ≥0.85, respectively. The MDC95 ranged from 5.82°to 8.18°for the intra-rater analysis and from 7.38°to 8.66° for the inter-rater analysis. The concurrent validity for flexion and extension between the 2 instruments was 0.85 and 0.91, respectively. Conclusions The iPhone®app possesses good to excellent intra-rater and inter-rater reliability and concurrent validity. It seems that the iPhone® app can be used for the measurement of lumbar spine flexion–extension ROM. Level of evidence IIb.

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

Motor control exercise for symptomatic lumbar disc herniation: protocol for a systematic review and meta-analysis

Measurement of wrist range of motion (ROM) is often considered to be an essential component of wrist physical examination. The measurement can be carried out through various instruments such as goniometers and inclinometers. Recent smartphones have been equipped with accelerometers and magnetometers, which, through specific software applications (apps) can be used for goniometric functions. This study, for the first time, aimed to evaluate the reliability and concurrent validity of a new smartphone goniometric app (Goniometer Pro©) for measuring active wrist ROM. In all, 120 wrists of 70 asymptomatic adults (38 men and 32 women; aged 18–40 years) were assessed in a physiotherapy clinic located at the School of Rehabilitation Sciences, Iran University of Medical Science and Health Services, Tehran, Iran. Following the recruitment process, active wrist ROM was measured using a universal goniometer and iPhone® 5 app. Two blinded examiners each utilized the universal goniometer and iPhone® to measure active wrist ROM using a volar/dorsal alignment technique in the following sequences: flexion, extension, radial deviation, and ulnar deviation. The second (2 h later) and third (48 h later) sessions were carried out in the same manner as the first session. All the measurements were conducted three times and the mean value of three repetitions for each measurement was used for analysis. Intraclass correlation coefficient (ICC) models (3, k) and (2, k) were used to determine the intra‐rater and inter‐rater reliability, respectively. The Pearson correlation coefficients were used to establish concurrent validity of the iPhone® app. Good to excellent intra‐rater and inter‐rater reliability was demonstrated for the goniometer with ICC values of ≥ 0.82 and ≥ 0.73 and the iPhone® app with ICC values of ≥ 0.83 and ≥ 0.79, respectively. Minimum detectable change at the 95% confidence level (MDC95) was computed as 1.96 × standard error of measurement × √2. The MDC95 ranged from 1.66° to 5.35° for the intra‐rater analysis and from 1.97° to 6.15° for the inter‐rater analysis. The concurrent validity between the two instruments was high, with r values of ≥ 0.80. From the results of this cross‐sectional study, it can be concluded that the iPhone® app possesses good to excellent intra‐rater and inter‐rater reliability and concurrent validity. It seems that this app can be used for the measurement of wrist ROM. However, further research is needed to evaluate symptomatic subjects using this app.

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

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.

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

Introduction Lumbar disc herniation (LDH) is a common condition in adults and can impose a heavy burden on both the individual and society. It is defined as displacement of disc components beyond the intervertebral disc space. Various conservative treatments have been recommended for the treatment of LDH and physical therapy plays a major role in the management of patients. Therapeutic exercise is effective for relieving pain and improving function in individuals with symptomatic LDH. The aim of this systematic review is to evaluate the effectiveness of motor control exercise (MCE) for symptomatic LDH. Methods and analysis We will include all clinical trial studies with a concurrent control group which evaluated the effect of MCEs in patients with symptomatic LDH. We will search PubMed, SCOPUS, PEDro, SPORTDiscus, CINAHL, CENTRAL and EMBASE with no restriction of language. Primary outcomes of this systematic review are pain intensity and functional disability and secondary outcomes are functional tests, muscle thickness, quality of life, return to work, muscle endurance and adverse events. Study selection and data extraction will be performed by two independent reviewers. The assessment of risk of bias will be implemented using the PEDro scale. Publication bias will be assessed by funnel plots, Beggs and Eggers tests. Heterogeneity will be evaluated using the I2 statistic and the χ2 test. In addition, subgroup analyses will be conducted for population and the secondary outcomes. All meta-analyses will be performed using Stata V.12 software. Ethics and dissemination No ethical concerns are predicted. The systematic review findings will be published in a peer-reviewed journal and will also be presented at national/international academic and clinical conferences. Trial registration number CRD42016038166.

The Effect of Core Stabilization Exercise on the Kinematics and Joint Coordination of the Lumbar Spine and Hip During Sit-to-Stand and Stand-to-Sit in Patients With Chronic Nonspecific Low Back Pain (COSCIOUS): Study Protocol for a Randomized Double-Blind Controlled Trial

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.