Design, Implementation, and Evaluation of Flipped Classroom for Postgraduate Physiotherapy Students

Introduction: Teamwork is an essential component of delivering successful physiotherapy services to patients; therefore, the education of physiotherapy students should be directed toward strategies that promote interaction between classmates. A flipped classroom (FC) is a pedagogical strategy that promotes active learning. The present study aimed to design, implement, and evaluate the FC for postgraduate physiotherapy students. Materials and Methods: A total of 44 postgraduate general and sport physiotherapy students participated in this study from 2016 to 2019. Two theoretical courses were designed and delivered based on the FC approach. The data were collected using a questionnaire that contained 12 items based on the 5-point Likert scale. The data were analyzed using descriptive statistics, Mann-Whitney, and Fisher exact tests. Results: The students’ familiarity with FC was 2.52±1.51 (median=3). The total agreement with FC was 3.42±0.92 (median=3). Only 22.7% of the students reported no increase in motivation. Meanwhile, 71% of the students agreed with a blended classroom, while only 52% preferred to teach only with FC. Conclusion: Most students preferred a blended classroom combining in-class and home activities. Also, the FC could augment the interaction and motivation of the students. Accordingly, FC is a valuable teaching strategy for postgraduate physiotherapy students

A comprehensive screening protocol to identify incidence of lower back pain in military office workers

Military workers experience different types of lower back pain (LBP), but there is little evidence concerning the incidence of LBP in this group, especially in Asian countries. One of the most common forms of LBP is discogenic low back pain (DLBP) which is a consequence of internal disc disruption accounting for approximately 40% of LBP cases. This cross-sectional study aimed to determine the incidence of non-specific low back pain (LBP), discogenic LBP, and other forms of LBP in military office workers in Iran. 564 military office workers (303 men and 261 women, age: 20-50 years), who had worked in this setting for at least two years, were randomly selected from one military office. The Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) was used as the primary screening tool. Participants who reported severe and mild LBP (graded low, mild, and severe) received a detailed physical examination including radiological magnetic resonance imaging. Based on the results of the physical examination, in conjunction with individual history, and medical opinion, mild-to-severe LBP was evident in 39% (n = 220) of the participants. Of these, non-specific LBP accounted for 60%, discogenic LBP accounted for 31%, and other forms of LBP accounted for the remaining 9% of the sample. We found that LBP is highly incident in military office workers, with non-specific LBP being the most incident form. Considering these high incidence rates, a strategy for preventive health screening and exercise intervention should be considered in this population to help reduce absenteeism and increase workforce productivity

A double-blind randomized controlled trial for the effects of dry needling on upper limb dysfunction in patients with stroke

Spasticity is one of the main complications of a stroke. This double-blind, randomized controlled trial aimed to compare the result of three sessions of dry needling (DN) versus sham DN on the affected upper limbs in post-stroke survivors. We recruited 24 patients (age 57.0 ± 9.6 years; male 71%). Patients were randomly allocated to two groups: a DN group and a sham DN group. The primary outcome measures were the Modified Modified Ashworth Scale (MMAS) and the Box and Block Test (BBT). Secondary outcome measures included active and passive wrist range of motion (AROM and PROM). All assessments were measured at baseline, immediately after the last session of the intervention, and one month later. Patients in the DN group had improved upper limb spasticity and passive wrist range of motion compared to control group (P0.05). Dry needling is a useful method for improving muscle spasticity in the upper limbs of patients with stroke

Multimodal impact of acupuncture, exercise therapy, and concurrent functional electrical stimulation on osteoarthritis of the knee: a case report

Knee osteoarthritis (OA) causes functional limitation in weight-bearing activities including walking. To investigate the multimodal impact of acupuncture, exercise therapy, and concurrent functional electrical stimulation (FES) on knee osteoarthritis. We designed a multidisciplinary treatment package including acupuncture; home based exercise therapy, and concurrent functional electrical stimulation during treadmill walking. Outcomes measurements included the numerical rating scale (NRS), the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the Tampa Scale of Kinesiophobia (TSK). Measurements were completed at baseline and following the treatment phase which consisted of six individual sessions. A 48-year-old male, office worker presented with a history of chronic right knee. During the previous year, he was diagnosed with knee osteoarthritis after clinical physical examination by a sports medicine physician. Following our novel training intervention, the patient reported a reduction in pain intensity from 8 to 2 on the NRS, improved in all KOOS subscale scores, and improved in the TSK scale (reduction from 15 to 11). In addition, the patient reported that he was able to return to work and undertake normal activities of daily living with reduced knee pain. This case report showed that our novel multimodal intervention including six sessions of acupuncture, exercise therapy, and treadmill walking with functional electrical stimulation (FES) had a positive impact on knee pain and function in a middle-aged male with knee osteoarthritis

The Effect of Dry Needling on Lower Limb Dysfunction in Poststroke Survivors

Background: Spasticity is one of the main complications in poststroke survivors leading to difficulties in walking and standing resulting in high levels of disability. Objective: The aim of the study was to investigate the effects of deep dry needling on lower limb dysfunction in poststroke spastic patients. Methods: A randomized clinical trial conducted in poststroke survivors who were assigned to one of 2 groups: Deep dry needling (intervention group) and sham dry needling (control group). The primary outcome measures were Modified Modified Ashworth Scale (MMAS) and functional tests (timed up and go test, 10-meter walk test). Secondary outcome measures were active ankle dorsiflexion range of motion (AROM), passive ankle dorsiflexion range of motion (PROM), single leg stance test, and Barthel index. All measurements were assessed at baseline (T0), immediately after the third session 1 week later (T1), and 1 month after the end of the intervention (T2). Results: We recruited 24 patients (71% male; mean age 57 ± 10 years; 26.4 ± 1.8 kg•m−2; time since event: 25.2 ± 12.5 months). There were significant improvements in MMAS, timed up and go test, 10-meter walk test, Barthel scale, and PROM (P . 05). Conclusions: Deep dry needling decreases muscle spasticity and improves lower limb function and gait speed in poststroke survivors

Concurrent impact of bilateral multiple joint functional electrical stimulation and treadmill walking on gait and spasticity in post-stroke survivors: a pilot study

Background: Stroke causes multi-joint gait deficits, so a major objective of post-stroke rehabilitation is to regain normal gait function. Design and Setting: A case series completed at a neuroscience institute. Aim: The aim of the study was to determine the concurrent impact of functional electrical stimulation (FES) during treadmill walking on gait speed, knee extensors spasticity and ankle plantar flexors spasticity in post-stroke survivors. Participants: Six post-stroke survivors with altered gait patterns and ankle plantar flexors spasticity (4=male; age 56.8 ± 4.8 years; Body Mass Index (BMI) 26.2 ±4.3; since onset of stroke: 30.8 ±10.4 months; side of hemiplegia [L/R]: 3:3) were recruited. Intervention: Nine treatment sessions using FES bilaterally while walking on a treadmill. Main Outcome Measures: Primary outcome measures included the Modified Modified Ashworth Scale (MMAS), Timed Up and Go test (TUG), 10-m walking test, gait speed, and Functional ambulation category (FAC). Secondary outcome measures included the Step Length Test (SLT), and active range of motion (ROM) of the affected ankle and the knee. Measurements were taken at baseline (T0), at the end of last treatment (T1), and one month after the final treatment session (T2). Results: The TUG, 10-m walking test, gait speed, FAC, active ROM, and SLT all significantly improved following treatment (

Effect of intensive neuromuscular electrical stimulation on chronic neck pain: A case report

© Nova Science Publishers, Inc. Chronic neck pain is a relatively common problem that can interfere with daily activities, and it is often experienced following musculoskeletal injuries. To identify the impact of intensive neuromuscular electrical stimulation (INES) for reducing chronic neck pain in a 21-year-old female athlete, following a traumatic sports injury, which occurred two years earlier. A treatment package including three separate sessions of intensive neuromuscular electrical stimulation and exercise therapy were prescribed. Outcomes measurements were short form McGill pain questionnaire (SF-MPQ), visual analogue scale (VAS), and the neck disability index (NDI). Measurements were performed at baseline, following the intervention, and three months later. Following our intervention; VAS score decreased from 6/10 to 3/10, and 1/10 after three months; and NDI decreased from 54/100 to 18/100, and 10/100 after three months. A combination of INES and resistance training significantly reduced neck pain after three months in a female gymnast. Further research is required to determine the effectiveness of this combination of treatments in larger cohorts with more diffuse musculoskeletal conditions

Multimodal impact of acupuncture, exercise therapy, and concurrent functional electrical stimulation on osteoarthritis of the knee: a case report

Knee osteoarthritis (OA) causes functional limitation in weight-bearing activities including walking. To investigate the multimodal impact of acupuncture, exercise therapy, and concurrent functional electrical stimulation (FES) on knee osteoarthritis. We designed a multidisciplinary treatment package including acupuncture; home based exercise therapy, and concurrent functional electrical stimulation during treadmill walking. Outcomes measurements included the numerical rating scale (NRS), the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the Tampa Scale of Kinesiophobia (TSK). Measurements were completed at baseline and following the treatment phase which consisted of six individual sessions. A 48-year-old male, office worker presented with a history of chronic right knee. During the previous year, he was diagnosed with knee osteoarthritis after clinical physical examination by a sports medicine physician. Following our novel training intervention, the patient reported a reduction in pain intensity from 8 to 2 on the NRS, improved in all KOOS subscale scores, and improved in the TSK scale (reduction from 15 to 11). In addition, the patient reported that he was able to return to work and undertake normal activities of daily living with reduced knee pain. This case report showed that our novel multimodal intervention including six sessions of acupuncture, exercise therapy, and treadmill walking with functional electrical stimulation (FES) had a positive impact on knee pain and function in a middle-aged male with knee osteoarthritis

Virtual Reality Games for Rehabilitation of Upper Extremities in Stroke Patients

Introduction Stroke is one of the main causes of physical disability in which doing frequent and early exercise is imperative for rehabilitation. Virtual reality gaming has a high potential in rehabilitation leading to increased performance of patients. This study aimed to develop, validate and examine virtual reality games in chronic stroke patients. Methods This was a single before-after study. To determine the movements and content of games, 9 physiotherapists and 11 game designers were asked to participate in a questionnaire-based survey. Then, to evaluate the impact of games on rehabilitation, patients (N = 10; mean age = 52 ± 4.38) with chronic stroke were asked to play the games three times a week for four weeks. Outcomes included measurement of the ability to perform shoulder, elbow and wrist movements was performed using goniometric instrument, Modified Motor Assessment Scale (MMAS) was used to assess the functional ability of patients and muscle spasticity, and brunnstrom’s stages of recovery test was also used to assess spastic and involuntary muscle movement Results Games have positive effects on the horizontal abduction of shoulder (16.26±23.94, P= 0.02), horizontal adduction of shoulder (59.24±74.76, P= 0.00), supination of wrist (10.68±53.52, P = 0.02), elbow flexion (0.1±1.5, P= 0.00), and wrist flexion (0.06±1.34, P = 0.03). However, they had no effects on the flexion of shoulder, flexion of elbow, extension of elbow, and extension of wrist (p-value> 0.05). Conclusions The results showed that games improve the range of motion of the participants in terms of horizontal abduction and abduction of the shoulder, elbow flexion, and supination and flexion of the wrist. Due to the small sample size in this study, we recommend more studies with larger samples and a control group