The Use of Expert System in the Rehabilitation of Patients after Anterior Cruciate Ligament Arthroscopic Surgery: A Randomized Clinical Trial

Introduction: The Anterior Cruciate Ligament (ACL) plays a vital role in stabilizing the knee. ACL lesions cause joint instability and severe disturbances in physical function and balance. After ACL reconstruction surgery, patients' ability to perform daily activities is significantly reduced and rehabilitation programs are necessary. The objective of the present study was to use an expert system for virtual reality application with the Wii Fit system to run a rehabilitation program in patients after ACL reconstruction. Method: This pilot study was performed as a randomized clinical trial on 20 eligible patients in two treatment groups over four weeks; one group with an expert system-based program with Wii Fit (WF group) and the other group with a standard rehabilitation program (CT group). In the first phase of the study, an expert system was developed with the help of specialists, then in the clinical phase, all patients were evaluated and rehabilitated. In statistical analysis, paired t-test and independent t-test were used. Results: Findings from statistical analysis showed significant differences before and after rehabilitation between the two groups in pain (P<0.001), joint swelling (P<0.001), thigh girth (P<0.001), Knee range of motion (P=0.002), and functional status of patients with Single-leg hop for distance (P<0.001), and Single-leg hop for time (P=0.014). The results revealed a significant improvement in patients in the WF group compared to the CT group. Conclusion: The rehabilitation approach using the expert system for Wii Fit exercises has had significant effects on pain, swelling, range of motion, and patient performance compared to the usual rehabilitation method

The Study of Patellar Position and Iliotibial Band Length in Anterior Knee Pain Patients with High and Normal BMI

Background and aims: This paper investigates the relationship between patellar position and iliotibial band length with body mass index (BMI) in in patients with anterior knee pain. Methods: This cross-sectional study is presented in which 60 patients with anterior knee pain were enrolled and allocated in two groups; one with high BMI (N=30) [mean age: 37 and mean BMI 29.8] and the other with normal BMI (N=30) )[mean age:30 and mean BMI 22.6]. The main outcome measures were pain intensity (VAS), knee ROM, patellar position and iliotibial band length which were evaluated and compared in the groups. Independent sample t test, and Pearson Correlation test were applied to analyze the data. Results: The iliotibial band length showed a statistically significant difference between the groups (p =0.034). There were also significant differences in the knee flexion range and extension lag (respectively, p =0.037 and p =0.008). Pearson correlation showed a significant inverse correlation between BMI and positive Ober test results (r = - 0.57and p=0.0001). Also, a reverse correlation was observed between BMI and tightness of ITB (r=-0.55 and p=0.01) as well as a positive correlation between tightness of ITB and pain intensity in patient with high BMI (r=0.67 and p=0.001). Conclusion: Based on the results of this study, it can be concluded that a positive correlation between the tightness of ITB and BMI in patients with anterior knee pain, but there was no significant correlation between BMI and the position of the patella

A Comparative Study of Whole Body Vibration Training and Pelvic Floor Muscle Training on Women's Stress Urinary Incontinence: Three- Month Follow- Up

Objective: To determine whether Whole Body Vibration Training (WBVT) is effective at improving pelvic floor muscles strength in women with Stress Urinary Incontinence (SUI). Materials and methods: The study was designed as a randomized clinical trial. 43 women with SUI were randomly assigned in two groups; WBVT and Pelvic Floor Muscle Training (PFMT) and received interventions for four weeks. Pelvic floor muscle (PFM) strength, quality of life and incontinence intensity were evaluated. All measurements were conducted pre and post intervention and also after 3 months in all participants. The ANOVA and the independent sample t test were applied respectively to determine the differences in each group and between the groups. Results: This study showed the WBVT protocol in this study was effective in pelvic floor muscles strength similar to PFMT, and also in reducing the severity of incontinence and increasing I-QOL questionnaire score. We found significant differences in each group pre and post intervention (p = 0.0001); but no significant difference in comparison of two groups' outcomes. Also after three-month follow up, there was no significant difference between groups. Conclusion: The findings of this study showed the beneficial effects of WBVT in improving pelvic floor muscles strength and quality of life in patients with urinary incontinence in four-week treatment period and after three months follow up

A controlled randomized trial with a 12-week follow-up investigating the effects of medium-frequency neuromuscular electrical stimulation on pain, VMO thickness, and functionality in patients with knee osteoarthritis

Abstract Background One of the major contributors to disability in Knee osteoarthritis (KOA) patients is weakness in the Quadriceps Femoris muscle. Neuromuscular electrical stimulation (NMES) has been used in rehabilitation for patients suffering from muscle weakness. Thus, the purpose of the study was to assess the effectiveness of NMES and exercise therapy, for improving pain, muscle weakness and function among patients with KOA. Methods A randomized controlled trial was conducted with 75 female patients diagnosed with KOA. Participants were divided into three intervention groups: NMES-only, exercise therapy (Exs) alone, and a combination of NMES and exercise (NMES + Exs). All patients underwent 12 supervised treatment sessions, three times a week. Outcome measures included pain intensity measured by visual analog scale (VAS), knee flexion range of motion (FROM), thigh muscle girth (TG), thickness of the Vastus Medialis Oblique (VMO), timed up and go test (TUG), six-minute walk test (6MWT), and WOMAC scores. Statistical analyses (ANOVA and Kruskal–Wallis) methods were done to compare the amounts at the baseline, immediately after treatment and after 12 weeks. Results The NMES group exhibited a significant reduction in pain at the 12-week follow-up compared to the other groups(p = 0.022). The NMES + Exs group showed better outcomes in terms of FROM, TG, and VMO thickness post-intervention (p < 0.0001, p < 0.004, p = 0.003, respectively) and at the 12-week follow-up (p < 0.0001, p < 0.0001, p < 0.0001, respectively). Additionally, NMES was superior in improving TUG and 6MWT post-intervention (p < 0.0001, p = 0.038, respectively) and during the follow-up assessments (p < 0.0001, p = 0.029, respectively). The NMES + Exs group achieved better WOMAC stiffness scores at both post-intervention and follow-up evaluations (p < 0.0001, p < 0.0001, respectively). Furthermore, at the 12-week follow-up, NMES + Exs group outperformed the others in WOMAC pain and function subscales (p = 0.003, p = 0.017, respectively), while the NMES group demonstrated better WOMAC total scores compared to the other groups (p = 0.007). Conclusion The combination of NMES and exercise seems to be an efficient approach for managing KOA, as it enhances knee flexion range and TG, increases VMO thickness, and improves WOMAC scores. On the other hand, NMES alone was found to be effective in improving the physical function of KOA patients. Trial registration IRCT20101228005486N7 (06–02-2020)

The study of correlation between forward head posture and neck pain in Iranian office workers

Introduction Factors such as prolonged sitting at work or improper posture of head during work may have a great role in neck pain occurrence among office employees, particularly among those who work with computers. Although some studies claim a significant difference in head posture between patients and pain-free participants, in literature the forward head posture (FHP) has not always been associated with neck pain. Since head, cervical and thoracic postures and their relation with neck pain has not been studied in Iranian office employees, the purpose of this study was to investigate the relationship between some work-related and individual factors, such as poor posture, with neck pain in the office employees. Material and methods It was a cross-sectional correlation study carried out to explore the relationship between neck pain and sagittal postures of cervical and thoracic spine among office employees in forward looking position and also in a working position. Forty-six subjects without neck pain and 55 with neck pain were examined using a photographic method. Thoracic and cervical postures were measured using the high thoracic (HT) and craniovertebral (CV) angles, respectively. Results High thoracic and CV angles were positively correlated with the presence of neck pain only in working position (p 0.05). Conclusions Our findings have revealed that office employees had a defective posture while working and that the improper posture was more severe in the office employees who suffered from the neck pain