The efficacy of treadmill training on walking and quality of life of adults with spastic cerebral palsy: A randomized controlled trial

AbstractObjectives:We aimed to evaluate the efficacy of treadmill training on walkings peed and endurance and quality of life in ambulatory adults with spastic cerebral palsy (CP) versus traditional physiotherapy.Material & Methods, Participants (17 men, 13 women; mean (SD) age 25y, 9m (7y, 10m) range 18y- 45y) with GMFCS levels I, II, and III, from the Ra’ad Rehabilitation Goodwill Complex, randomly allocated to the experimental and the control groups. The trainings (treadmill for experimental group and conventional physiotherapy for control group) conducted two times a week for 8 consecutive weeks. Main outcome measures were the 10 meter walk test for the gait speed, the 6 minute walk test for the gait endurance and the WHOQOL- Brief questionnaire for the quality of life. Assessments had done at the baseline, ninth and 16th session (three times) during the treatment.Results: Although the experimental group showed a significant improve in the gait speed [1.08(0.47)m/s to 1.22(0.50)m/s](P=0.004) and in the gait endurance [291.13(160.28)m to 342.63(174.62)]( P=0/002), but between groups changes of the outcome measures of walking and quality of life were not significant.Conclusions: Treadmill training without body weight support would be no more effective than traditional physiotherapy to improve gait speed and endurance and quality of life in adults with spastic cerebral palsy. There is a hope to improve walking performance and function in adults with cerebral palsy.

Impaired Ipsilateral Upper Extremity Dexterity and Its Relationship with Disability in Post-Stroke Right Hemiparesis

Background: The objectives of this study were to compare manual dexterity (gross and fine) and coordination performance of the ipsilateral upper extremity of the right hemisphere stroke patients with the same side of a healthy group, and to determine the relationship of ipsilateral upper extremity dexterity and disability. Methods: In a non-randomized analytical study, 30 individuals with a unilateral first-ever stroke from outpatient rehabilitation clinics and 30 age and sex-matched adults without history of neurological disorders were enrolled. Purdue Pegboard, Box and Block, and Finger to Nose tests were used to measure dexterity (fine and gross) and coordination performance of the stroke group compared with the same hand of the healthy group. The Barthel index was also used to assess disability or dependency of stroke patients in basic activities of daily living. Results: Results showed that stroke individuals with involvement of ipsilateral hand had less coordination and dexterity when compared to the same hand of normal subjects (P=0.001). In addition, the relationship of gross and fine manual dexterity performance of the ipsilateral upper extremity with disability, including dependence in basic activities of daily living, were significant respectively (r=0.376, r=0.391). Conclusion: People with right stroke had significant ipsilateral upper extremity impairments (manual dexterity and coordination tasks), and this hand dexterity deterioration had an impact on their dependence in basic activities of daily living

Relationship Between Functional Mobility and Balance and Dependency in Activity of Daily Living in Elderly After “Hip Arthroplasty”

Objectives: The purpose of this study was to investigate correlation between functional mobility with balance and dependency in activity of daily living in elderly after “hip arthroplasty” (HA) and its comparison with healthy subjects. Methods & Materials: The current cross-sectional study was done on 15 patients with age mean and standard deviation (72±9.6) with hip osteoarthritis 6 months after “hip arthroplasty” (HA) and 15 healthy subjects with age mean and standard deviation (72.7±1.4) as control group. Patient group was assigned with non- probability convenient sampling and control group selected with matched assignment. Functional mobility measured with Timed Up & Go Test (TUG), functional balance with Functional Reach (FR) and Berg Balance Scale (BBS) and dependency in activity of daily living measured with Modified Barthel Index (MBI). Pearsons correlation coefficient used for stastistical analysis. Results: Results of this study indicated significantly and stronge correlation between functional mobility and balance and dependency in activity of daily living in patient group (r>0.50). Also medium correlation existed between functional mobility and balance with dependency in activity of daily living in control group (r>0.30). Conclusion: Functional mobility and balance and dependency in activity of daily living in the elderly who had HA showed significant positive correlation. In addition correlation between functional mobility and balance and dependency in activity of daily living in patient group is better and higher than healthy group

Mobility Compensatory Strategies in Individuals With Multiple Sclerosis (A Qualitative Study)

Background and Objectives: The complications and motor disorders caused by multiple sclerosis (MS) not only affect the individual’s movement abilities but also play a crucial and valuable role in how these individuals carry out their daily activities. In this way, patients with MS use certain compensatory methods, depending on individual differences, their environment, and their family’s support, to help with the complications of this disorder. For this reason, this study aims to identify the compensatory strategies that people with MS use to adapt to their mobility limitations. Methods: In this study, 13 patients with MS (7 women and 6 men), with informed consent, an average age of 43 years, and a qualitative content analysis approach, were included in the study. The sampling was performed purposefully with maximum variation, and the data was collected via quasi-structured in-depth interviews. Immediately after each interview, the data was analyzed using Cheevakumjorn`s method. Results: After analyzing the data and extracting the resulting codes, the codes were classified according to their similarities and differences. Ultimately, three main components of “compensatory strategies for home mobility”, “compensatory strategies for outdoor mobility”, and “compensatory strategies for carrying out daily activities” were formed. Conclusion: Although families play a major role in compensating for the mobility problems of these patients, it is necessary for health providers to reduce the burden placed on their families, and to educate MS people on self-care and adjust their living environment. Furthermore, providing mobility assistive devices for the patients should be done according to their differences and their environment

Mobility Barriers for People with Multiple Sclerosis: a Qualitative Study

Background & Objectives: The purpose of this study was to identify the experiences of people with multiple sclerosis (MS) from mobility barriers they are faced with. Methods: This study included 13 patients with MS (7 women and 6 men), with informed consent, whose average age is 43 years. A qualitative content analysis approach was used. According to the EDSS criteria, the severity of their disability was between 8-4. The sampling was carried out purposefully with maximum variation, and the data was collected through semi-structured in-depth interviews. Immediately after each interview, the data was analyzed using the Cheevakumjorn`s method.  Results: After analyzing the obtained data and categorizing the resulting codes; three main categories were observed: “disease-affected barriers”, “personal barriers” and “environmental barriers”. The data of each theme were classified as subthemes.  Conclusion: Based on research findings and experiences of the participants, rehabilitation specialists during the assessment, management and treatment of patients with MS should alert and educate patients about personal mobility barriers and try to help them fit in their physical environment

Pain-Related Disability Measurement: The Cultural Adaptation And Validation of Pain Disability Index (PDI)” and “Pain Disability Questionnaire (PDQ)” Among Lranian Low BackPain Patients

Background: Low Back Pain (LBP) is still a medical problem in 21 st century. Having back pain and being disabled by it are not the same thing. It is common to come across with patients who have simple back pain but surprisingly totally disabled and vice versa. In clinical practice, it is important to have a proper evaluation of disability and making a clear distinction between pain and disability. During the past two decades several selfreport measures and questionnaires have been developed to evaluate disability in LBP patients, however most of these questionnaire were designed in English language and based on European or American studies. The aim of this study was to develop and validate a translated and culturally adapt “Pain Disability Index (PDI)” and “Pain Disability Questionnaire (PDQ)” among Iranian patients with low back pain. Methods: The Persian versions of the PDI, PDQ were created through systematic translation and crosscultural adaptation of the original questionnaires. The Oswestry Disability Index and Visual Analogue Scale were used for validation studies. Patients were asked to complete these questionnaires initially and also at 7 days later as retest.Results: A total of 304 patients with acute and chronic LBP completed the Persian versions of PDI, PDQ,“Oswestry Disability Index” (ODI) and “Visual Analogue Scale” (VAS). Among patients 111 patients participated for retest after seven days. The Cronbach’s alpha (coefficient of reliability) for the PDI and PDQ was satisfactory. The PDI and PDQ showed high and very high test-retest reliability (ICC=0.8 and 0.92 respectively). The Pearson correlation coefficient among PDI, PDQ with ODI was 0.64 and 0.72, and for PDI, PDQ, ODI with VAS was 0.36, 0.47 and 0.57, respectively (P<0.001).Conclusion: The Persian version of the PDI and PDQ questionnaires are reliable and valid instruments to evaluate generic perceived disability in Persian-speaking patients with LBP. It is shown that PDI and PDQ are capable of measuring the disability in LBP patients. They could be used in clinical and research encounters with acceptable confidence

Relationship between Quality of Life and Hypertonia in Young Adults with Spastic Cerebral Palsy

Background: The complications associated with spastic cerebral palsy can affect the physical ability and quality of life of individuals suffering from this motor disorder. The aim of this study was to assess the relationship between quality of life and hypertonia in adults with spastic cerebral palsy. Methods: In an analytical cross sectional study, 70 subjects with the diagnosis of spastic cerebral palsy from three Ra’ad Rehabilitation Goodwill complexes in Tehran and Karaj cities took part in this study through convenient sampling. The severity of spasticity and contracture of the knee flexors were measured by Modified Tardieu Scale. Also the quality of life was assessed through World Health Organization quality of life-BREF questionnaire. To analyze data, Pearson and spearman correlation coefficient were used. Results: Participants of this study were 42.90% male, 57.10% female with mean age 26.24±5 years. No correlation existed between quality of life with knee flexor muscles spasticity. However, psychological and environmental domains showed low correlations with knee extension range (respectively r=0.26 and r=0.28; P<0.05). Conclusion: The influences of the mechanical component of hypertonia (contracture) on the quality of life are more prominent than neural factors such as spasticity

Association between spasticity and the level of motor function with quality of life in community dwelling Iranian young adults with spastic cerebral palsy

Abstract Background: Consequences of cerebral palsy in adulthood can affect physical, psychological capabilities and quality of life. The purpose of this study was to investigate the relationship between quality of life with spasticity and level of motor function in Iranian young adults with spastic cerebral palsy who were community dweller. Methods: In an analytical cross sectional study, 77 participants with spastic cerebral palsy (44 women، 33 men) with age range of 20 to 40 years; (mean age 26.19±5 yr) took part in this study. They were enrolled from three Raad Rehabilitation Goodwill complexes in Tehran and Karaj cities. All subjects were recruited through convenient sampling. Severity of Spasticity for knee flexors was measured with Modified Tardieu Scale. In addition, the level of motor function, and quality of life were assessed respectively through Gross Motor Function Classification System and World Health Organization Quality of life questionnaire (WHOQOL- BREF). To analyze data, Pearson and spearman correlation coefficient was used. Results: No correlation found between quality of life with knee flexor muscles spasticity and level of motor function (p&gt; 0.05). Conclusion: Quality of life as a multi dimensional concept has been impacted by many factors such as physical status, environmental issues and culture. Possibly, severity of spasticity and level of function have a less pronounced effect on quality of life in community dwelling adults with cerebral palsy

Cross-Cultural Adaptation and Determination of the Validity and Reliability of the Persian Version of the Patient-Rated Tennis Elbow Evaluation (PRTEE) Questionnaire in Iranian Tennis Players

Background and Objectives: The objective of this study was to evaluate the cross-cultural adaptation of the Persian version of the Patient-Rated Tennis Elbow Evaluation (PRTEE) in Iranian tennis players with lateral epicondylitis. Materials and Methods: The original version of the PRTEE questionnaire was translated into the Persian language by two bilingual translators in accordance with the instructions provided by Beaton et al. One hundred and two tennis players (64 males and 38 females) suffering from lateral epicondylitis and 40 tennis player with no lateral epicondylitis participated in this study. In order to determine the construct validity, the correlation between the Persian version of the PRTEE and disabilities of the arm, shoulder and hand questionnaire (DASH) were all investigated. The reliability of the questionnaire was determined from two different aspects of the test-retest reliability and internal consistency. Results: There was a high correlation between PRTEE and DASH questionnaires (r = 0.88). The coefficient of Cronbach’s alpha for the total score of the PRTEE questionnaire was 0.96 and the intra-class correlation (ICC) coefficient for the total score was 0.95. There was a significant difference in the scores of patients (M=45.56, SD=20.56) and healthy (M=7.23, SD=5.5) tennis players; (t =17.31, P<0.0001). Conclusion: The Persian version of the PRTEE questionnaire to assess pain and functional problems in patients with lateral epicondylitis is highly reliable and valid in this setting

Effect of multidimensional physiotherapy on non-specific chronic low back pain: a randomized controlled trial

Abstract Background Many people with non-specific chronic low back pain (NSCLBP) do not recover with current conventional management. Systematic reviews show multidimensional treatment improves pain better than usual active interventions. It is unclear whether multidimensional physiotherapy improves pain better than usual physiotherapy. This study determines the effectiveness of this treatment to reduce pain and disability and improve quality of life, pain cognitions, and electroencephalographic pattern in individuals with NSCLBP. Methods 70 eligible participants aged 18 to 50 years with NSCLBP were randomized into either the experimental group (multidimensional physiotherapy) or the active control group (usual physiotherapy). Pain intensity was measured as the primary outcome. Disability, quality of life, pain Catastrophizing, kinesiophobia, fear Avoidance Beliefs, active lumbar range of motion, and brain function were measured as secondary outcomes. The outcomes were measured at pre-treatment, post-treatment, 10, and 22 weeks. Data were analyzed using intention-to-treat approaches. Results There were 17 men and 18 women in the experimental group (mean [SD] age, 34.57 [6.98] years) and 18 men and 17 women in the active control group (mean [SD] age, 35.94 [7.51] years). Multidimensional physiotherapy was not more effective than usual physiotherapy at reducing pain intensity at the end of treatment. At the 10 weeks and 22 weeks follow-up, there were statistically significant differences between multidimensional physiotherapy and usual physiotherapy (mean difference at 10 weeks, -1.54; 95% CI, -2.59 to -0.49 and mean difference at 22 weeks, -2.20; 95% CI, − 3.25 to − 1.15). The standardized mean difference and their 95% confidence intervals (Cohen’s d) revealed a large effect of pain at 22 weeks: (Cohen’s d, -0.89; 95% CI (-1.38 to-0.39)). There were no statistically significant differences in secondary outcomes. Conclusions In this randomized controlled trial, multidimensional physiotherapy resulted in statistically and clinically significant improvements in pain compared to usual physiotherapy in individuals with NSCLBP at 10 and 22 weeks. Trial Registration ClinicalTrials.gov NCT04270422; IRCT IRCT20140810018754N11