Development and Standardization of a Questionnaire for Quality Assessment of Clinical Education Provided by Faculty Members of Rehabilitation School

Background and Objectives: Teaching clinical skills to students who provide health services is of great importance. Many universities use questionnaires to make qualitative assessments about the teaching of these skills based on the students’ point of view. In many cases, the learning environment affects teaching; however, this issue is not often taken into account while designing questionnaires. In addition, it is necessary to specialize the questionnaires because the clinical trainings of different medical groups differ from each other. The aims of this study were 1, to develop a questionnaire that could be used for quality assessment of clinical education provided by faculty members of rehabilitation school and 2, to evaluate the validity and reliability of such a questionnaire. Methods: Based on the clinical education curriculums of the departments of rehabilitation school, a questionnaire consisting of two sections assessing teaching quality (24 items) and learning environment (7 items) was designed. Face and content validity of the questionnaire was approved during several feedback stages based on the opinions of the faculty members. In addition, the reliability of the questionnaire was evaluated by administering it to 25 undergraduate students during a given time interval. Results: Using Cronbach’s alpha, the internal consistency values of the questionnaire for teaching quality and learning environment components were found to be 0.94 and 0.73, respectively. The results of the test-retest reliability were as follows: intraclass correlation coefficient (ICC) of 0.95 and 0.96; Pearson correlation coefficient of r = 0.92 and r = 0.93, and paired t-test of P > 0.05. Conclusions: Both the teaching quality and learning environment sections in the designed questionnaire were found to be valid and reliable. The results showed that the questionnaire could be used to assess the quality of clinical education provided by faculty members in rehabilitation schools. Keywords: Assessment, Clinical Education, Questionnaire, Rehabilitation School, Validity, Reliability, Learning Environmen

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

Effects of dry needling and exercise therapy on post-stroke spasticity and motor function- protocol of randomized clinical trial.

Background: Spasticity is one of the most common problems after the first stroke. Dry needling (DN) has been presented as a new therapeutic approach used by physiotherapists for the management of post-stroke spasticity. This study aimed to determine whether the addition of exercise therapy to the DN results in better outcomes in wrist flexors spasticity, motor neuron excitability, motor function and range of motion (ROM) in patients with chronic stroke. Methods: We will use a single-blind randomized controlled trial (RCT) in accordance with the CONSORT guidelines. A total of 24 patients with stroke will be included from the University Rehabilitation Clinics. The outcome measures will include Modified Modified Ashworth Scale, Hmax/Mmax ratio, H-reflex latency, Action Research Arm Test, Fugl-Meyer Assessment, and wrist extension active and passive range of motion. Patients in the DN and exercise therapy group will undergo 4 sessions of deep DN in flexor carpi radialis and flexor carpi ulnaris muscles on the affected upper limb and exercise therapy. Participants in the DN group will only receive DN for target muscles. Clinical and neurophysiological tests will be performed at baseline, after four therapy sessions, and at three weeks’ follow-up. Discussion: This study will provide evidence for additional effects of exercise therapy to DN in comparison to DN alone on wrist flexors spasticity, motor neuron excitability, upper-limb motor function, and ROM in patients with chronic stroke

Investigating post-stroke fatigue: An individual participant data meta-analysis

The prevalence of post-stroke fatigue differs widely across studies, and reasons for such divergence are unclear. We aimed to collate individual data on post-stroke fatigue from multiple studies to facilitate high-powered meta-analysis, thus increasing our understanding of this complex phenomenon.Methods: We conducted an Individual Participant Data (IPD) meta-analysis on post-stroke fatigue and its associated factors. The starting point was our 2016 systematic review and meta-analysis of post-stroke fatigue prevalence, which included 24 studies that used the Fatigue Severity Scale (FSS). Study authors were asked to provide anonymised raw data on the following pre-identified variables: (i) FSS score, (ii) age, (iii) sex, (iv) time post-stroke, (v) depressive symptoms, (vi) stroke severity, (vii) disability, and (viii) stroke type. Linear regression analyses with FSS total score as the dependent variable, clustered by study, were conducted.Results: We obtained data from 14 of the 24 studies, and 12 datasets were suitable for IPD meta-analysis (total n = 2102). Higher levels of fatigue were independently associated with female sex (coeff. = 2.13, 95% CI 0.44–3.82, p = 0.023), depressive symptoms (coeff. = 7.90, 95% CI 1.76–14.04, p = 0.021), longer time since stroke (coeff. = 10.38, 95% CI 4.35–16.41, p = 0.007) and greater disability (coeff. = 4.16, 95% CI 1.52–6.81, p = 0.010). While there was no linear association between fatigue and age, a cubic relationship was identified (p < 0.001), with fatigue peaks in mid-life and the oldest old.Conclusion: Use of IPD meta-analysis gave us the power to identify novel factors associated with fatigue, such as longer time since stroke, as well as a non-linear relationship with age

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Effect of Somatosensory Impairments on Balance Control

Background and Aim: The somatosensory system is one of the most effective systems in balance control. It consists of peripheral and central components. Knowing the role of these components in balance control assists the developing of effective rehabilitation protocols. In some diseases peripheral components and in others central components are impaired. This paper reviews the effect of impairment of peripheral and central components of the somatosensory system on balance control.Methods: In this study publication about somatosensory impairments from 1983 through 2011 in PubMed, Scopus, ProQuest, Google Scholar, Iran Medex, Iran Doc and Magiran were reviewed. Medical subject headings terms and keywords related to balance, somatosensory, somatosensory loss, and sensory integration/processing were used to perform the searches.Conclusion: Somatosensory impairments either with peripheral or central origin, can cause problems in balance control. However, these problems are not considered in some patients. In these impairments, balance training is recommended to be used alongside other routine treatments in the patients&apos; rehabilitation programs

The Effects of Listening to Persian Music on the Hand Dexterity and Depression in a Patient with Stroke: A Case Report

Introduction: Nowadays the use of music therapy for neurological disorders in developed countries is widely emphasized. Despite this, there is little scientific evidence regarding the use of this method for the treatment of Iranian patients with stroke. Case report: Since Iranian patients are more familiar with Persian music, this study was performed to describe the effects of listening to the Persian music played with Daf (an Iranian music instrument) in a 54-year-old man with chronic stroke. Discussion: This case report could show for the first time, the positive effect of passive listening to Persian music with Iranian Daf instrument on the hand dexterity and depression in a patient with chronic stroke

The Effects of Lower Extremity Muscle Fatigue on Dynamic Balance in Volleyball Players

Objectives: Lower extremity muscles are critical for maintaining dynamic balance and athletic performance. Fatigue of these muscles may affect dynamic balance. It is unclear whether fatigue in a particular muscle group can affect dynamic balance more than that in other groups. This study was conducted to evaluate and compare the effects of fatigue in 5 muscle groups on dynamic balance in volleyball players. Methods: Fifteen healthy male volleyball players separately performed the Star Excursion Balance Test before and immediately after the occurrence of fatigue of ankle Plantar Flexor (PF), knee extensor, knee flexor, hip abductor, and hip adductor muscles. Composite reach distance and distance in anterior, posteromedial, and posterolateral directions were recorded, accordingly. Results: Repeated-measures Analysis of Variance (ANOVA) data indicated that fatigue of all muscle groups significantly decreased the mean score of composite (P<0.001). Anterior, posteromedial, and posterolateral distance scores decreased following muscle fatigue of knee extensors and ankle PFs (P<0.05). Discussion: This study suggested that regarding composite reach score, fatigue of ankle, knee, and hip muscles similarly decreased dynamic balance. However, evaluating three main directions revealed that knee extensors and ankle PFs muscles fatigue presented more prominent effects on the explored volleyball players’ balance, compared to the other muscles

Effects of tension of Kinesio taping application on maximum quadriceps torque and knee repositioning sense in recreationally males

Background: Sports injuries of the knee joint are very common. There are both contact injuries and non-contact injuries. Contractile injuries may be due to an impairment of the knee joint position sense or a decrease of the quadriceps muscle strength. Using a Kinesio taping method may decrease this impairment. The aim of the current study was to assess the effect of direction and tension of Kinesio taping of the quadriceps muscle on repositioning sense of the knee joint and maximum concentric and eccentric torque of the knee extensors. Methods: Twenty-one recreationally active healthy males, determined by convenient non-probability sampling method, participated in this quazi-experimental study. The tests were performed in biomechanics laboratory of School of Rehabilitation of Tehran University of Medical Sciences, Iran, between July to November 2017. They visited biomechanics laboratory 5 sessions. The first session was for familiarization with the main tests and signing an informed consent form. For 2 through 5 sessions, one of each Kinesio tape tension approaches of 100, 115 and 140 percent (origin to insertion direction) and 100 percent (insertion to origin direction) was randomly applied on the quadriceps muscle. Active and passive repositioning sense of the knee joint at 60-degree flexion and maximum concentric and eccentric torque of the knee extensors of the dominant extremity before and after Kinesio taping were measured using a Biodex System 3 isokinetic dynamometer (Biodex Medical Systems, Shirley, NY, USA). Order of measuring active and passive repositioning sense and maximum concentric and eccentric torque of the knee extensors were randomly selected. Results: Origin to insertion Kinesio taping method with tension of 100, 115 and 140 percent significantly decreased means of active and passive repositioning sense errors (P 0.05). Conclusion: According to the results, Kinesio taping could influence on repositioning sense of the knee joint at 60-degree knee flexion. Maximum concentric and eccentric extensor torques was also increased