A New 4-DOF Robot for Rehabilitation of Knee and Ankle-Foot Complex: Simulation and Experiment

Stationary robotic trainers are lower limb rehab robots which often incorporate an exoskeleton attached to a stationary base. The issue observed in the stationery trainers for simultaneous knee and ankle-foot complex joints is that they restrict the natural motion of ankle-foot in the rehab trainings due to the insufficient Degrees of Freedom (DOFs) of these trainers. A new stationary knee-ankle-foot rehab robot with all necessary DOFs is developed here. A typical rehab training is first implemented in simulation, and then tested on a healthy subject. Results show that the proposed system functions naturally and meets the requirements of the desired rehab training.Comment: 23 pages, 14 figure

Responsiveness of Minimal Clinically Important Change for the Persian Functional Rating Index in Patients with Chronic Low Back Pain

Study Design A prospective, within-group cohort study of 46 patients with chronic low-back pain (CLBP). Purpose To assess the responsiveness of the Persian Functional Rating Index (PFRI) and to determine the minimal clinically important change (MCIC) of the PFRI in a cohort of patients with CLBP. Overview of Literature The FRI is an instrument for assessing pain and disability in patients with low-back pain. No study so far has examined the responsiveness of the PFRI. Methods Forty-six patients with CLBP with a mean age of 50.33±14.28 completed the PFRI, the Persian Roland–Morris Disability Questionnaire (PRMDQ), and a Visual Analog Scale (VAS) before and after 10 physiotherapy sessions. A Global Rating of Change Scale (GRCS) was completed after treatment. Results The changes in PFRI scores were statistically significant using the paired t-test (p<0.001). The PFRI revealed high effect sizes (range, 0.93–1.82). The PFRI showed significant correlations with the VAS (0.86), the PRMDQ (0.66), and the GRCS (0.45). The area under the receiver operator characteristic curve for the PFRI was good (0.76; 95% confidence interval, 0.56–0.95). The MCIC for PFRI was 10.63 points. Conclusions The results supported the responsiveness of the PFRI in patients with CLBP and showed the amount of change in PFRI scores perceived as worthwhile by the patients

Decomposing socioeconomic inequality in poor mental health among Iranian adult population: results from the PERSIAN cohort study

Background Socioeconomic inequality in mental health in Iran is poorly understood. This study aimed to assess socioeconomic inequality in poor mental health among Iranian adults. Methods The study used the baseline data of PERSIAN cohort study including 131,813 participants from 17 geographically distinct areas of Iran. The Erreygers Concentration index (E) was used to quantify the socioeconomic inequalities in poor mental health. Moreover, we decomposed the E to identify factors contributing to the observed socioeconomic inequality in poor mental health in Iran. Results The estimated E for poor mental health was - 0.012 (95% CI: - 0.0144, - 0.0089), indicating slightly higher concentration of mental health problem among socioeconomically disadvantaged adults in Iran. Socioeconomic inequality in poor mental health was mainly explained by gender (19.93%) and age (12.70%). Region, SES itself, and physical activity were other important factors that contributed to the concentration of poor mental health among adults with low socioeconomic status. Conclusion There exists nearly equitable distribution in poor mental health among Iranian adults, but with important variations by gender, SES, and geography. These results suggested that interventional programs in Iran should focus on should focus more on socioeconomically disadvantaged people as a whole, with particular attention to the needs of women and those living in more socially disadvantaged regions. Keywords:Mental health; Socioeconomic inequality; Concentration index; Decompositio

A “Period-Based” Approach to Interpreting the Term “Order in Affairs” in the Quote “I Advise You to Fear Allah and Keep Order in Affairs”

In Letter 47 of Nahjolbalaghe, Imam Ali (PBUH) introduces three important issues including the fear of God, order in affairs and peace among people. The term “order in affairs” has become synonymous in recent centuries with individual order – that is, the placement of every object in its position. But based on the evidence available in the context of the letter including sensitive situations in the period, addressees of the letter, literal and applied meanings of order at the time and other expressions used by Imam (PBUH), it seems that another meaning was originally meant by “order in affairs”. In a lexical study, it can be figured out that the word order had some social sense of “consistency” in earlier periods while some recent dictionaries consider an individual meaning for it in addition to the social meaning. The synthesis of different views by interpreters and some translators of Nahj al-Balagha concerning the term “order in affairs” points to the social sense of “unity and consistency”. Applications of the words “order” and “affairs” in Nahj al-Balagha and other texts highlight the sense of “consistency” for the word order as its original meaning and the senses of “work”, “diversity” and “management” for the word affairs. The views of some contemporaries about the term “order in affairs” suggest that the meaning of unity for order is the common ground. However, some have pointed to the sense of keeping up the government/ regime as the accurate meaning of affairs. Finally, it can be concluded that the term “order in affairs” in this quote from Imam Ali (PBUH) suggests his emphasis on the concept of unity

The Effects of Active Straight Leg Raising on Tonicity and Activity of Pelvic Stabilizer Muscles

Objective: Active straight leg raising (SLR) test is advocated as a valid diagnostic method in diagnosis of sacroiliac joint (SIJ) dysfunction that can assess the quality of load transfer between trunk and lower limb. The aim of this study is Comparison of changes in tonicity and activity of pelvic stabilizer muscles during active SLR, between healthy individuals and patients with sacroiliac joint pain. Materials & Methods: A case – control study was designed in 26 women (19-50 years old). With use of simple sampling, surface electromyography from rectus abdominis, external oblique, internal oblique, adductor longus, erector spine, gluteus maximus and biceps femoris was recorded in 26 subjects (15 healthy females and 11 females with sacroiliac pain) in resting position and during active SLR test. Resting muscle tonicity and rms during ramp time and hold time in active SLR test were assessed by non parametric-two independent sample test. Results: Biceps femoris activity in resting position was significantly larger in patients group (P<0.05). During the active SLR, the women with sacroiliac joint pain used much less activity in some pelvic stabilizer muscles compared to the healthy subjects (P<0.05). Conclusion: The increased resting tonicity of biceps femoris and decreased activity of pelvic stabilizer muscles in subjects with sacroiliac joint pain, suggests an alteration in the strategy for lumbopelvic stabilization that may disrupt load transference through the pelvis

Cash Effective Tax Rate as a Criterion of Tax avoidance or Earnings Management

The purpose of this paper is to examine whether cash effective tax rate is a suitable criterion for measuring tax avoidance? The sample includes 102 firms (including 714 firm-year observations) with positive pre-tax income and listed in Tehran Stock Exchange (TSE) for the period from 2005 to 2912. To test hypotheses, panel data method is used. Results suggest that the cash effective tax rate is not a suitable criterion to measure tax avoidance; because, this rate reflects two distinct effects of tax avoidance and upward earnings management at the same time. This is due to the pre-tax income in denominator which can be affected by activities designed to manage pre-tax income. Using this rate for measuring tax avoidance in researches affected also by earnings management, may distort the results

(Reliability of a system consists of skin markers, digital photography, and AutoCAD software for measuring the knee angles)

Background and aim: In physical evaluations, measuring the joint angle is one of the most important outcomes to assess the patient’s progress, the effectiveness of various treatment techniques and to delineate the need for future treatments. The aim of this study is to study the reliability of a system consists of skin markers, digital photography, and AutoCAD software for measuring the knee joint angles. Materials and methods: In first section, reliability of markers placement was evaluated within three different intervals (five minutes, two days, and twenty days). At second section, reliability of digital photography was evaluated while position of the skin markers and subjects was the same. At the end, in third section, reliability of angle measurement by means of AutoCAD software was assessed. Results: In first section, the ICC for test-retest reliability of markers placement between first and second sessions, first and third sessions, and also first and forth sessions were 0.97, 0.94, and 0.73, respectively. In second section, the ICC for test-retest reliability of digital photography was 0.99 and in third section, the ICC for intra-rater reliability of angle measurement by means of AutoCAD software was 0.99 (p=0.05). Conclusion: It was noted that the introduced system was highly reliable, so it could be utilized to measure the knee joint angles

(The effect of chronic ankle instability on knee joint position sense)

Background and Aim: The rapid growth of the athletic training profession has been accompanied by an equally rapid increase in focus on basic and clinical research. Lateral ankle sprain (LAS) is an extremely common athletic injury. Despite extensive clinical and basic science research, the recurrence rate remains high. Chronic ankle instability (CAI) following LAS is hypothesized to predispose individuals to re-injury because of neuromuscular control deficits which result following injury. No investigation has been carried out on the existence of joint position deficits in the knee joint of patients with CAI. In this study, joint position sense (JPS) was evaluated in patients with CAI. Materials and Methods: Ten female patients with CAI and ten healthy control subjects participated in this study. JPS was evaluated by reproduction of the angles in two standing and sitting positions, and in each position two target angles were tested. The knee joints in both lower limbs of patients and the dominant knee-limb of healthy subjects were evaluated. The knee angles were measured by using a system comprised of skin markers, digital photography, and Auto CAD software. Absolute error was considered as a dependant variable. Result: There were no significant differences between the knee JPS of dominant leg in healthy subjects and both knee joints of patients. There were also no significant differences between knee JPS in two standing and sitting positions and in two different target angles (p>0/05). Conclusion: The result of this study suggests that subjects who have CAI do not have deficit in knee JPS when tested in sitting position and also under functional weight bearing conditions

Effects of combining diaphragm training with electrical stimulation on pain, function, and balance in athletes with chronic low back pain: a randomized clinical trial

Background: It is unknown how diaphragm training combined with electrical stimulation affects pain, function, static stability, and balance in athletes with chronic low back pain (CLBP). This study aimed to explore the effects of combining diaphragm training with electrical stimulation on pain, function, static stability, and dynamic balance in athletes with nonspecific CLBP. Methods: The design was a randomized clinical trial. A total of 24 amateur athletes (12 women, 12 men, mean age: 35.2 ± 9.8) with nonspecific CLBP were randomly allocated into two groups. The experimental group (n = 12) received diaphragm training plus Transcutaneous Electrical Nerve Stimulation (TENS), while the control group (n = 12) received TENS alone. Both groups underwent 12 sessions over a four-week period. Static stability, dynamic balance, pain, and function were measured pre- and post-intervention. Results: Analysis of variance 2 × 2 revealed greater improvements in pain (p < 0.001), static stability (p < 0.001), and dynamic balance (p < 0.01) in the experimental group compared to the control group. Function was improved in both groups following the interventions (p < 0.001), and there was a trend of a larger improvement in the experimental group than the control group (p = 0.09). Fisher’s exact test showed that the experimental group reported ≥50% improvement only in the pain score, not function, compared to the group that received TENS alone (p = 0.005). Conclusions: Pain, function, static stability, and dynamic balance were improved in both groups following 12 intervention sessions. However, pain, static stability, and dynamic balance were improved to a greater extent in diaphragm training plus TENS than TENS alone in amateur athletes with CLBP. Therefore, it seems beneficial to add diaphragm training to the rehabilitation program for athletes with nonspecific CLBP. Trial registration: The trial was retrospectively registered in the Iranian Registry of Clinical Trials (www.irct.ir) on September 10, 2020 as IRCT20090228001719N8. Keywords: Back pain, Diaphragm muscle, Breathing exercises, Transcutaneous electrical nerve stimulatio

Additional file 2 of Home care nurses’ perception of the challenges they faced during the COVID-19 pandemic: a qualitative study

Additional file 2: Supplement Table2. Consolidated criteria for reporting qualitative studies (COREQ): 32-item checklist