THE BALANCED SCORECARD (BSC) METHOD: FROM THEORY TO PRACTICE

Abstract Performance management has become a legislative requirement for the private and local sectors. Unfortunately, not many tools exist to measure and monitor public and private service delivery effectively. Managersrequire accurate information to ensure that their decisions are not based on emotions and assumptions, but that theinformation with regard to service delivery is accurate and relevant. In modern business models, intangible assets suchas employee skills and knowledge levels, customer and supplier relationships, and an innovative culture are critical inproviding the much-needed cutting-edge to the organization. This is where tools like the balanced scorecard methodhold relevance for the enterprise. Developed by Robert Kaplan and David Norton, the balanced scorecard methodtranslates an organization's strategy into performance objectives, measures, targets and initiatives. It is based on four balanced perspectives, and links them together with the concept of cause and effect. A proper balanced scorecard canpredict the effectiveness of an organization's strategy through a series of linked performance measures based on fourperspectives including: 1.Finance, 2.Customers, 3.Internal processes, 4.Employee learning and growth

Intra-Examiner and Between-Day Reliability of Algometer for Pressure Pain Threshold and Pain Sensitivity in Upper Trapezius Muscle in Asymptomatic Young Adult Women

Assessment of pain sensitivity, as an important criterion, is used in diagnosis of musculoskeletal impairments, which helps determine prognosis as well as the improvement rate after treatment interventions. Regarding the costs of modalities and treatment equipment used to reduce pain, having a reliable method to determine their efficacy is essential. The aim of the present study was to evaluate intra-examiner and between-day reliability of an accessible digital algometer to assess pressure pain threshold and for pain sensitivity for the first time. A total of 15 healthy young adult women aged 18-30 participated in the study. Three points of upper Trapezius muscle in both sides were tested in 3 repetitions with 30 seconds rest interval. The tests included PPT by controlled speed of increasing pressure and Visual Analogue Scale to evaluate local pain elicited by exertion of 2.5 kg/cm2 of pressure on the marked point. Trials were conducted on two consecutive days. Intra Class Correlation, Coefficient Standard Error of Measurement, and Minimal Detected Change were calculated to analyze the reliability of the measurements. Assessments revealed high to moderate intra-examiner reliability for pressure pain threshold (ICC>0.972) and pain sensitivity (ICC>0.707) and high to moderate between-day reliability for pressure pain threshold (ICC>0.974) and pain sensitivity (ICC>0.676). Although pressure algometer has an acceptable intra-examiner and between-day reliability for estimating the pressure pain threshold and pain sensitivity, a significant decrease was revealed in the mean values of PPT and increase in PS on the second day, as compared to that on the first day, (P<0.05) which could be related to local tissue trauma, learning effect, or central sensitization.Key words: Reliability; Intra-Examiner; Between-Day; Algometer; Pressure Pain Threshold; Pain Sensitivity; Upper Trapeziu

Spinal Stabilization Exercise with and without Whole–Body Vibration: A Randomized Controlled Clinical Trial

Introduction: The present study aimed to compare the impacts of core stability exercises with and without Whole Body Vibration (WBV) training sessions lasting two weeks on trunk muscle endurance in patients with non-specific chronic low back. Methods and Materials: Thirty participants were randomly placed into either a WBV group or a spinal stabilization group at Shahid Beheshti University of Medical Sciences, Tehran, Iran, in 2013. The dependent variables manipulated included the abdominal and spinal muscular endurance, assessed prior to, midway through, and after two weeks and the WBV or spinal stabilization intervention program implemented using stabilizer pressure biofeedback unit and Biering Sorensen test. Results: Changes in transverse abdominal and internal oblique muscle endurance in prone position were statistically significant among the participants in both groups (P<0.05). However, changes in transverse abdominal muscle endurance in supine position and multifidus muscle endurance were not observed to be statistically significant in both groups. In addition, inter-group analysis showed that except for the percentage of changes of multifidus muscle endurance, the vibration group demonstrated significant improvement over the non-vibration group. Conclusion: As no significant difference was observed between the two treatment methods, none of treatment methods was more effective comparatively in terms of improving mid-term trunk muscle endurance.Keywords: Whole body vibration, Trunk muscle endurance, Non-specific chronic low back pain, Core stabilit

Comparison of Psychometric Properties of the Original and Brief Version of the Tampa Scale for Kinesiophobia

Introduction: Some accurate tools exist to assess fear-avoidance behavior, such as the Tampa scale for kinesiophobia (TSK) in individuals with musculoskeletal problems. The current research aims to compare the psychometric characteristics of the original 17-items TSK questionnaire and its 11-item brief version in chronic non-specific low-back pain (CNSLBP). Materials and Methods: In this test development study, 295 patients with CNSLBP referred to the physiotherapy clinic of Milad Hospital in Tehran city, Iran were evaluated. Confirmatory factor analysis (CFA) and α Cronbach was conducted to assess the validity and reliability of the original and brief version of the TSK, respectively. For goodness-of-fit, the Χ2/df, root mean square error of approximation (RMSEA), goodness-of-fit index (GFI), and comparative fit index (CFI) indices were used. Results: Internal consistency specified by Cronbach’s α was 0.949 for the original version of the questionnaire and 0.927 for the brief one. Based on the CFA findings, the goodness-of-fit indices for the brief version were GFI=0.921, RMSEA=0.078 (90% confidence interval (CI), 0.062%-0.094%), comparative fit index (CFI)=0.981, and Χ2/df=2.791. These indices for the original one were 0.882, 0.066 (90% CI, 0.055%-0.076%), 0.983, and 2.270, respectively. A significant correlation was found between these two versions (P<0.001). These findings confirm the adequacy of the brief version of the TSK. Conclusion: The brief version of TSK can be considered a reliable and valid tool to evaluate somatic focus and activity avoidance in patients with CNSLBP

Sustaining the National Spinal Cord Injury Registry of Iran (NSCIR-IR) in a Regional Center: Challenges and Solutions

Background: The National Traumatic Spinal Cord Injury Registry in Iran (NSCIR-IR), was implemented initially in three hospitals as a pilot phase from 11 Oct 2015 to 19 Jun 2016 and has been active in eight centers from 19 Jun 2016. Poursina Hospital, a trauma care referral center in Rasht, Guilan Province of Iran is one of the registry sites, and has been involved in registering eligible patients since 1 Jan 2016. This study aimed to identify the challenges and solutions for sustaining the NSCIR-IR in a regional center. Methods: This was a mixed-methods study. For the quantitative analysis, a retrospective observational design was used to measure case capture or case identification rate, mapping cases in the registry against those eligible for registry inclusion amongst the register of hospital admissions. For the qualitative component, data was collected using focus group discussions and semi-structured interviews, followed by thematic analysis. Results: From 19 Jun 2016 to 24 Jan 2018, the proportion of case capture (case identification rate) was 17%. The median time between case identification and data entry to the system was 30.5 d (range: 2 to 193 d). Thematic analysis identified a lack of trained human resources as the most important cause of low case identification rate and delay in data completion. Conclusion: Recruitment and education to increase trained human resources are needed to improve case capture, the timeliness of data input and registry sustainability in a regional participating site

Comparison of the Immediate Effects of Various Durations of Trigger Point Compression Technique on Latent Trigger Points of the Upper Trapezius Muscle

Introduction: The aim of the present study was to investigate the immediate effect of time (30 and 90 seconds) trigger point compression techniques in the latent trigger points of upper trapezius muscle. Methods and Materials: A total of 39 women, aged between 20-30 who were diagnosed with latent MTrPs in the upper trapezius muscle, participated in the present study. Participants were randomly assigned to 3 groups, 13 each, using block randomization method: trigger point compression (30 sec), trigger point compression (90 sec), and control group. In all groups, the measurements were carried out before and after the intervention. Results: The duration of 30 and 90 sec trigger point compression techniques were observed to decrease the pain and increase the pain pressure threshold (P&lt;0.001). Significant differences were found between the duration of 30 sec trigger point compression technique and control group in terms of pain magnitudes (P&lt;0.001) and pain pressure threshold (P&lt;0.01). Also, there were significant differences between the duration of 90 sec trigger point compression technique and control group regarding pain magnitudes and pain pressure threshold (P&lt;0.001). Moreover, significant differences were observed between these 2 treatment groups in terms of pain magnitudes (P&lt;0.05) and pain pressure threshold (P&lt;0.001). The duration of 90 sec trigger point compression technique was observed to have more effects compared with that for duration of 30 sec. Conclusions: The results of the present study indicated that each of the 2 treatments decreased pain and increased pain pressure threshold. The results introduce the duration of 90 sec trigger point compression technique as a more effective treatment compared with that of the duration of 30 sec for latent MTrPs.Key words: Compression Technique; Myofascial Trigger Points; Upper Trapeziu

Intra-Examiner and Inter-Examiner Reliability of Goniometer for Active Cervical Contra-Lateral Flexion and Algometer for Pressure Pain Threshold in Upper Trapezius Muscle in Asymptomatic Young Adult Women

Introduction: Measurement of Active Cervical Contra-Lateral Flexion (ACCLF) and Pressure Pain Threshold (PPT) is an integral part of the patients' assessment with myofascial pain syndrome and cervical disorders. This study aimed to investigate the inter- and intra-examiner reliability of goniometer in measuring ACCLF and algometer in measuring PPT in the upper trapezius muscle. Materials and Methods: ACCLF and PPT in upper trapezius muscle were measured in 20 healthy young adult female volunteers. Measurements were performed in two sessions one hour apart by two examiners, each consisting of 3 trials with 60-second rest periods. Data analysis was performed using the Interclass Correlation Coefficient (ICC) and Standard Error of Measurement (SEM). Results: For ACCLF measurement with the goniometer, the intra-examiner reliability was as follows: first examiner in first session=0.985, first examiner in second session=0.959, and the inter-examiner reliability was first session=0.954 and second session=0.969. For PPT measurement with the algometer, the intra-examiner reliability was as follows: first examiner in first session=0.928, first examiner in second session=0.877 and the inter-examiner reliability were: first session=0.742 and second session=0.866. Conclusion: Goniometer and algometer exhibited a good inter- and intra-examiner reliability in measuring ACCLF and PPT, respectively, in the upper trapezoid muscle. Keywords: Cervical Contra-lateral Flexion; Inter-examiner; Intra-examiner; Pressure Pain Threshold; Reliabilit

An Ultrasonographic Investigation of Craniocervical Extensor Muscles in Patients with Chronic Non-specific Neck Pain

Introduction: The purpose of the present study was to measure the thickness and the strength of craniocervical extensor muscles in men with chronic non-specific neck pain and healthy controls. Materials and Methods: Fifteen men with chronic non-specific neck pain (CNNP) and 15 healthy controls were participated in this study. The thicknesses of the craniocervical extensor muscles (rectus capitis posterior major(RCPM)) and oblique capitis superior (OCS) in addition to the strength of upper cervical extensor muscles were measured at resting position and during maximal voluntary isometric contraction (MVIC) of craniocervical extensor muscles using ultrasonography device and a dynamometer which was designed for the purpose of study. Results: The thicknesses of RCPM and OCS muscles were significantly smaller in the patients group than the healthy controls at resting position and during maximal isometric contraction (P&lt;0.001). There was a significant reduced MVIC in patients with CNNP when compared to controls (P=0.008). Conclusion: The reduced craniocervical extensor muscles strength and thickness in patients with CNNP may be due to pain and reflex inhibition which is originating from cervical neuromusculoskeletal structures. Craniocervical muscles assessments may be needed while evaluating patients with CNNP.Keywords: Craniocervical, Muscle, Neck, Pain, Strength, Thickness, Ultrasonograph

Evidence of familial resemblance and family-based heritability of food intakes derived from a longitudinal cohort study

Abstract We sought to investigate the familial aggregation and family-based heritability of dietary intakes among adults in a population-based longitudinal study of the Tehran Lipid and Glucose Study (TLSG). Total of 4359 males and 5439 females entered our study. We categorized foods into main groups based on the literature on main food groups and their subgroups among the Iranian dietary habits and food culture as follows: grains, fruits, vegetables, dairy, meats, legume, nuts, beverages, snacks, and fats. The intraclass correlation coefficients (ICC) are estimated to verify familial resemblance of dietary habits for all relative pairs and spouses. Family-based heritability is obtained using a mixed effect framework with likelihood-based approach. For almost all food groups, the correlation between parents and offsprings tended to be larger than those of siblings. Family-based heritability of food groups varies from the lowest 6.36% for snacks to the highest 25.67% for fruits, and 25.66% for legume. Our findings indicated weak-to-moderate similarities between parents' and offspring's food intakes; however, the similarity in parent–child food intakes was different, and the correlation in mother-daughter food intakes was stronger than other parent–child correlations, and almost all of dietary components showed strong family-based heritability

Familial resemblance and family-based heritability of nutrients intake in Iranian population: Tehran cardiometabolic genetic study

Abstract Background We aimed to investigate the familial resemblance of dietary intakes, including energy and nutrients, and the family-based heritability of dietary intake in different age-sex dyads of the Tehran cardiometabolic genetic study. Methods This cross-sectional study was conducted on 9,798 participants, aged ≥ 18 years, with complete data in each of the third, fourth, fifth, and sixth surveys of the Tehran Cardiometabolic Genetic study, who were eligible to enter the current study based on inclusion and exclusion criteria. Nutrient intake was determined using a valid and reliable food frequency questionnaire (FFQ). FCOR command of the S.A.G.E. software was used to estimate the intra-class correlation coefficients of all relative pairs to verify the family resemblance of dietary nutrient intakes. Classical likelihood-based is used to assess the family-based heritability of dietary nutrient traits. Results There were 4338 families with a mean family size of 3.20 ± 2.89, including 1 to 32 members (2567 constituent pedigrees and 1572 singletons) and 3627 sibships. The mean ± SD age of participants was 42.0 ± 15.2 years, and 44.5% were males. The heritability of nutrient intake ranged from 3 to 21%. The resemblance degree of energy intake and most nutrients between spouses or between parents and children is weak to moderate; however, a high resemblance of intake was observed for some food components, especially among spouses, including trans fatty acids (TFAs) (r:0.70), chromium (r:0.44), fiber(r:0.35), pantothenic acid (r:0.31), and vitamin C(r:0.31). Based on our findings, the resemblance of nutrient intake in spouses was greater than in parent-offspring. The similarity in parent–offspring nutrient intake was different, and the correlation in mother-girls nutrient intakes was greater than other parent–child correlations. Also, the lowest resemblance in nutrient intake was observed among siblings. Conclusions Our findings suggested a weak-to-moderate similarity between the nutrient intakes of parents and offspring. The resemblance degree in nutrient intake varied between different family pairs; the strongest correlation of nutrients was observed between spouses, which includes TFAs, chromium, fiber, pantothenic acid, and vitamin C. The lowest correlation of nutrients was between siblings, such as carbohydrates, thiamine, niacin, and vitamin K. An individual's nutrient intake can somewhat be influenced by genetics, family relationships, and the effects of parents, although the significant influence of environmental factors should not be ignored