Comparison of bone mineral density measured by dual X-ray, axial dual-energy photon X-ray absorptiometry and laser absorptiometry of calcaneus

The objective of this study was to validate the use of bone mineral measurements of the calcaneus bone by dual X-ray and laser (DXL) in a cross-sectional study carried out in an osteoporosis clinic. Measurements of bone mineral density (BMD) at proximal femur and spine were obtained by dual-energy photon X-ray absorptiometry (DEXA). Osteoporosis was defined by a DEXA T-score <-2.5 at the femoral neck or lumbar spine. Sensitivity, specificity and kappa statistics for DXL were calculated, assuming the DEXA measurement as the gold-standard. The study included 475 women with a mean age of 54±11.9 years. 15 had osteoporosis while 39 were osteopenic (-2.5<T-score between<-1) at the femoral neck or spine. A significant correlation (p<0.001) was found between BMD values as measured by DXL at femoral neck and DEXA at the lumbar spine. Assuming the same T-score cut-off value for the diagnosis osteoporosis and a modified cut-off value for the diagnosis of osteopenia (-2.5<T-score<-1.5), yields a sensitivity of 83 and a specificity of 74 to 86 for the DXL device. In conclusion, BMD measured at the calcaneal bone by DXL, has a good correlation with that measured by axial DEXA

The effect of rocker shoe on the ground reaction force parameters in patients with rheumatoid arthritis

Objectives: Foot and ankle problems are common complications in rheumatoid arthritis disease. Gait pattern such as normal foot and ankle rocker is impaired in patients with rheumatoid arthritis. Rocker sole as an external shoe modification is commonly prescribed in this pathology. The aim of this study was to investigate the effect of rocker shoe on vertical ground reaction force parameters during walking in patients with rheumatoid arthritis. Methods: Sixteen female participants with rheumatoid arthritis were recruited in this study. All patients were prepared with a pair of high-top, heel-to-toe rocker shoe and were asked to wear the shoes for one month. Ground reaction force parameters including peak forces and peak force times were evaluated in the first session, and after seven days and thirty days follow up were carried on. Results: First maximal vertical force was significantly increased with rocker shoe compared to barefoot after 7 days follow up. Walking with rocker shoe reduced the minimal vertical force after 7 days. The second maximal vertical force showed to be statistically lower with rocker shoe than barefoot after 7 and 30 days. Furthermore, stance time decreased with rocker shoe after one month. Discussion: Results of this study revealed that vertical ground reaction force parameters changed in rheumatoid arthritis patients with heel-to-toe rocker shoe, both immediately and after one month follow up. This might suggest the effectiveness of rocker shoes in improving gait in rheumatoid arthritis patients

Intra-articular ozone or hyaluronic acid injection:Which one is superior in patients with knee osteoarthritis? A 6-month randomized clinical trial

Purpose: Knee osteoarthritis (OA) is a common disease, imposing a great burden through pain and decreased function. There are many therapeutic modalities including non-pharmacologic choices and oral, topical, and intra-articular medications. New studies have shown promising results for ozone application in knee OA. Our aim was to compare the effects of ozone therapy versus hyaluronic acid (HA) intra-articular injection in knee OA patients. Methods: In this randomized clinical trial, a total of 174 patients with more than 3 months of chronic pain or swelling in the knee joints along with consistent imaging findings were enrolled and randomly allocated into two groups of HA and ozone, which were planned to undergo 3 weekly injections of HA (Hyalgan®) and 10 mL of a 30 µg/mL ozone solution, respectively. Patients were evaluated at baseline and 6 months after the last injection for pain, stiffness, and function using the visual analog scale (VAS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire. Results: No major adverse events were detected in this study. Total WOMAC score decreased from 40.8±9.8 to 20.4±4.9 (p<0.01) in the ozone group and from 38.5±7.9 to 17.1±4.2 (p<0.01) in the HA group. A similar trend was observed in pain improvement according to VAS. Pain, stiffness, and function significantly improved in both the groups, but no between-group difference was found. Conclusion: Although both ozone and HA can be effectively used for improving function and reducing pain in selected knee OA patients, neither of the two showed any superiority at 6-month follow-up. © 2018 Raeissadat et al

Reliability and Validity of the Persian Version of the Mini-Balance Evaluation Systems Test in Patients with Stroke

Background: Stroke can cause balance disorders, which often lead to falls and fall-related injuries. The Mini-Balance Evaluation Systems Test (Mini-BESTest) is a balance test that has been recently translated into Persian. The reliability and validity of the Persian version of Mini-BESTest have not been assessed in patients with stroke. Objectives: To assess the reliability and validity of the Persian version of the Mini-BESTest in patients with stroke. Methods: A cross-sectional study was designed. Thirty patients with stroke participated in this study. Patients were tested using the Mini-BESTest according to the Persian instructions, and two raters independently rated each patient�s performance. Each patient was matched with a healthy adult in the terms of age and gender. Healthy subjects were also tested for discriminative validity. Results: There was excellent correlation between two raters on the Persian version of the Mini-BESTest total scores (rPearson = 0.98, P &lt; 0.001) and its sections (rPearson &gt; 0.9). There was a significant difference between stroke patients and healthy subjects confirming the discriminative validity of the Persian version of the Mini-BESTest (19.4 ± 5.4 vs. 24.8 ± 2.3, P &lt; 0.001). Limitations: We only assessed stroke patients, and the results may not be generalized to other patients with balance deficits. Conclusions: The Persian version of the Mini-BESTest is a reliable and valid tool for balance evaluation of stroke patients. © 2020, The Author(s)

Subject-specific and function-specific applicability of a hand-forearm musculoskeletal model

There is ambiguity on the quantitative validity of the predictions revealed by musculoskeletal models for muscle forces. This study investigated the consistency between the predictions of a musculoskeletal model of the upper limb and the experimental data for a number of different subjects and functional tasks. Six normal subjects performed isokinetic eccentric or isotonic concentric contraction tests of the wrist muscles in well controlled conditions, using a robotic apparatus, and the net joint torque and angular velocities, as well as the surface electromyograms (EMG) signals of the muscles, were recorded. The experiments were then simulated using a parametric musculoskeletal model of hand and forearm, scaled for each subject. Muscle activation was determined based on the optimization of a polynomial or min-max objective function. Comparison of the model predictions with the normalized EMGs revealed more consistent results for the polynomial objective function. In general, the model could reflect the change of the net joint torque on the activation level, but the effects associated with the velocity of movement were not sufficiently reflected. Stronger correlations between model predictions and normalized EMGs, were obtained for subjects with smaller body mass indices (BMIs), 0.738, and those who experienced higher muscular excitations, 0.908. The sensitivity analysis of the model also indicated a high sensitivity (9.5) to the joint torque but a minimal sensitivity (0.3) to the joint velocity. The sensitivity indices for the muscle's length and physiological cross-sectional area (PCSA) were 11.2 and 5.3, respectively. It was concluded that our musculoskeletal model was highly sensitive to the anatomical data, as well as the muscles' excitation levels, but not to the contraction velocity. © 2015 National Taiwan University

No immediate analgesic effect of diadynamic current in patients with nonspecific low back pain in comparison to TENS

Background and design: Chronic nonspecific low back pain (CNSLBP) has major socioeconomic as well as personal impact in many industrialized and developing countries. Physiotherapy is a common intervention for this group of patients and using anti-pain physical modalities is a common part of the physical therapy. In a randomized controlled trial we investigated the immediate effect of the Diadynamic current in comparison to TENS on reducing the pain in patients suffering from non specific chronic low back pain. Methods: Thirty patients were randomized into the Diadynamic current and TENS groups. Electrical stimulation was applied for 10 min in the Diadynamic group and for 15 min in the TENS group for one session. Pain, on a 100 mm Visual Analog Scale, and Pressure Pain Threshold (PPT), using an Algometer, was measured before the treatment, after the current application, 20 min later and after 48 h. Results: Pain was decreased significantly after 20 min following the current application only in the TENS group, with no improvement at all measurement points in the group receiving Diadynamic current. PPT was increased immediately after current application in both groups but did not last until later measurements. Conclusion: Diadynamic current had no positive effect on prompt relief of pain in patients suffering from recurrent CNSLBP. © 2017 Elsevier Lt

Effects of insole with toe-separator and night splint on patients with painful hallux valgus: A comparative study

The objective of this study was to compare the effects of wearing an insole with toe separator and night splint on hallux valgus and intermetatarsal angles and also on the intensity of pain in patients suffering from painful hallux valgus deformity. Subjects in this study consisted of 30 female patients aged 19-45 years (mean 27.83 ± 8.91) who were divided into two groups. The first group received the insole and toe separator and the second group received night splint. Hallux valgus angle and intermetatarsal angle were radiographically measured before and after a 3-month study period. Foot pain intensity was assessed by 10 cm Visual Analogue Scale before and after intervention. After statistical analysis the reduction of pain was significant in the first group (p<0.05) whereas in the second group no significant difference was obtained. The hallux valgus angle and intermetatarsal angle decreased in both groups; however, the reduction was not significant. According to the results of this study, using night splint seems to have no effect on painful hallux valgus deformity. On the other hand, although the insole with toe separator significantly decreased the pain intensity in these patients and was a good option for pain reduction, it was not effective in improvement of the great toe angles

Adding high-frequency transcutaneous electrical nerve stimulation to the first phase of post anterior cruciate ligament reconstruction rehabilitation does not improve pain and function in young male athletes more than exercise alone: a randomized single-blind clinical trial

Purpose: Knee ligamentous trauma and the following pain is one of the most prevalent athletic injuries. Transcutaneous electrical nerve stimulation is one of the conservative approaches in controlling pain which is low cost, noninvasive, and safe with low complications. Our purpose was to study whether transcutaneous electrical nerve stimulation (TENS) could help athletes perform better during the first phase of rehabilitation (0�4 weeks) after anterior cruciate ligament (ACL) reconstruction surgery and until the follow-up. Methods: This randomized single blind (exercise instructor and assessor) clinical trial was performed on 70 male athletes, undergone ACL surgery. After the surgery, patients were randomly divided into two groups: the first group received semi-supervised exercise plus high-frequency TENSTENS for 35 min a day and the second group only performed exercises. Treatment duration continued for 20 sessions, 4 weeks. The visual analog scale (VAS) score (100 mm), International Knee Documentation Committee (IKDC) questionnaire and knee flexion Range of motion (ROM) were evaluated for all patients after the surgery (before commencing the rehabilitation program), after 4 weeks and 14 weeks from the surgery. Results: Mixed ANOVA was used to explore the interaction effects of time and group on outcome measures and post hoc additional tests were performed on the data. The VAS, IKDC questionnaire score and knee flexion ROM increased in both groups over time, but the amount of improvement did not differ between the two groups, implying no additional improvement in the group receiving TENS along with exercises. Conclusion: The findings of the present trial shows that adding TENS to a specific protocol of semi-supervised exercise in the first phase of rehabilitation after ACL reconstruction is not efficient on improving knee function and pain more than exercise alone.Implications for Rehabilitation Injury to the anterior cruciate ligament of the knee is a common injury specifically in athletes. Incorporating effective pain relieving strategies during the post anterior cruciate ligament reconstruction surgery rehabilitation could lead to improvement in regaining the range of motion and function of the knee which is of crucial importance after the surgery. Applying transcutaneous electrical nerve stimulation alongside a specific protocol of semi-supervised exercise in the first phase of rehabilitation after anterior cruciate ligament reconstruction did not have any additional effect to exercise alone. © 2017, © 2017 Informa UK Limited, trading as Taylor & Francis Group