Barriers and facilitators of receiving prosthetic services in people with lower limb amputation during Covid-19 pandemic: A qualitative study in a developing country

PURPOSE

This study investigated the barriers, challenges, and facilitators in receiving prosthetic services in people with lower limb amputation during Covid-19 pandemic.

MATERIALS AND METHODS

In this qualitative study, we conducted in-depth semistructured face-to-face interviews with individuals with lower limb amputation who needed prosthetic services during Covid-19 pandemic. We discussed about challenges and barriers that the participants had encountered during this period. The collected data were analyzed using a conceptual framework.

RESULTS

Six broad themes of availability, accessibility, acceptability, affordability, accommodation, and awareness emerged from the analysis. Staff shortage, lack of remote services, accommodation, insurance and governmental support, and cost of services were the main concerns. Moreover, long waiting lists, postponed referrals, noncompliance with Covid-19 protocols and preventive measures, and lockdowns were the other important concerns that were noted. In addition, unsatisfactory services in hometown, distance to capital, transportation permit in lockdowns, traffic jam, and public transport problems were other reasons of service not being accessible. The positive aspects were the facilitators such as having home visits, social work and charity, and using private drive services.

CONCLUSION

It seems that after the beginning of Covid-19 pandemic, people with lower limb amputation have faced more drastic challenges in accessing and receiving prosthetic services than in the prepandemic situations.

Additional effect of neuromuscular electrical stimulation in a conservative intervention on morphology and strength of abductor hallucis muscle and correction of hallux valgus deformity: a randomized controlled trial

BACKGROUND

In hallux valgus, morphological changes and functional weakness of intrinsic foot muscles occur, especially in the abductor hallucis muscle.

OBJECTIVES

This study aimed to investigate how a conservative treatment with the addition of neuromuscular electrical stimulation affects the volume and strength of the muscle, the correction of deformity, passive range of motion, pain, and disability.

METHODS

Twenty-eight female participants (48 feet) were randomly assigned to two groups. The interventions included orthoses and exercise (Ortho) in both groups. One group received additional neuromuscular electrical stimulation of abductor hallucis muscle to activate it. Each group received the treatments for one month and was assessed two times, at baseline before starting and after one month of treatment. Mixed within-between ANOVA, analysis of covariance, and nonparametric tests were used for data analysis.

RESULTS

The muscle volume, abduction strength, goniometric angle, and passive hallux dorsi/plantar flexion showed significant changes in both groups (p < .001). Subscales of the foot and ankle ability questionnaire, significantly changed (p ≤ .05). Pain decreased significantly in the two groups (p < .001 and p = .02). Intermetatarsal angle did not significantly differ between the two groups (p = .86, partial eta effect size = 0.001). But, the hallux valgus angle mean (on MRI) in the Ortho group was less than that of the orthoNMES group (p = .007, partial eta effect size = 0.15).

CONCLUSION

Both groups showed nearly identical treatment effects in the primary volume and hallux valgus correction outcome measures. In this study, adding neuromuscular electrical stimulation did not have an additional effect compared to conservative in the treatment of hallux valgus.

TRIAL REGISTRATION NUMBER

The RCT Code is IRCT20200915048725N1.

Applying systems thinking in the prosthetics and orthotics sector: investigating the common challenges in Iran

PURPOSE

We sought to explore the common challenges across stakeholder groups and also to recognize interactions among them to improve the Iranian prosthetics and orthotics (P&O) sector.

MATERIALS AND METHODS

Interviews were performed from January to June 2019. Participants, including 13 prosthetists/orthotists and six P&O faculty members, were selected using purposive and snowball sampling. The collected data were analyzed using the framework analysis method. Additionally, a systems thinking approach was applied to theorize potential leverage points to improve P&O services in Iran.

RESULTS

Challenges in leadership and governance included lack of united stewardship, inappropriate inter-sectoral cooperation, and poor awareness among decision-makers. Financing challenges included high out-of-pocket payments, inadequate insurance coverage, and insufficient governmental funding. Service delivery challenges included lack of prosthetists and orthotists in hospitals and medical centers, corrupt activities and a weak referral system. Human resource challenges included insufficient practical skills of graduates, misalignment of theoretical and clinical training, and inadequacy of continuing education courses.

CONCLUSIONS

This study provides the groundwork to develop and implement national strategies to address modifiable barriers and improve prosthetic and orthotic services.Implications for rehabilitationLack of united stewardship, inappropriate inter-sectoral cooperation, and poor awareness among decision-makers are the governance challenges of prosthetics and orthotics (P&O) and must be managed by the government.Government resources allocated to P&O services should increase, and P&O insurance coverage should improve.P&O services should be incorporated in health benefits packages to lessen the reliance on out-of-pocket payments.Planning should be done toward inclusion of P&O services in universal health coverage.Up-to-date scientific training and high-quality evidence are needed to enhance the practical skills of P&O graduates and consequently improve the quality of P&O services.Effective continuing training courses for P&O graduates are recommended.It is advantageous to provide P&O services in hospitals.

Lived experience of children and adolescents with lower-limb loss who used a prosthesis: A qualitative study

PURPOSE

Children's and adolescents' level of activity, the type of activity, and other features are special to them and can result in unique experiences with lower-limb prosthesis. The specific objective of this study was to explore the lived experience of children and adolescents with lower-limb loss (LLL) who used a prosthesis.

METHODS

We used a descriptive qualitative study design and in-depth, semistructured, face-to-face interviews. Accordingly, 35 participants, including children and adolescents with LLL who used a prosthesis, their parents, and prosthetists, were interviewed. The collected data were analyzed thematically.

RESULTS

One hundred sixty-eight codes about the experiences of children, parent(s), and prosthetists were extracted from the transcripts and categorized into 32 subthemes. Finally, 7 broad themes including suitability, provoke reactions, intrinsic nature, infrastructures, the school, availability, and parenting role were extracted.

CONCLUSION

The experiences of children and adolescents with lower-limb prosthesis are specific as each may face unique challenges and deal with different difficulties. In this study that has been conducted in a developing country, the main challenges faced by children using lower-limb prosthesis and their parents are the prosthetic components, social reactions, long distance, and costs of services. Moreover, designing a more natural prosthesis and gait training for children with LLL were the most important issues faced by prosthetists. However, close relationships with friends and family members, and children's amazing ability to adapt can aid in facilitating prosthetic management.

Exploring the carry-over of top-down attentional settings in dynamic conditions

A top-down attentional set can persist from a relevant task to an irrelevant task, influencing allocation of attentional resources, visual search, and performance. While this "carry-over" effect has been found across numerous experiments, past studies have utilised paradigms that present similar tasks to the same spatial location. The present research explored whether attentional settings persist in more dynamic situations. In Experiment 1, participants played a computer game that encouraged a horizontal, vertical, or random spread of search. After 10 or 30 s, they moved 90° to their right and monitored a driving video for hazards. Eye movements to the videos were not affected by the characteristics of the preceding game, revealing no carry-over of attentional settings. One possible explanation for this was the visuospatial shift between the tasks. To explore this further, Experiment 2 adopted a similar paradigm to previous research; participants searched horizontal, vertical, or random letter strings before completing an image search. In one block the tasks were presented to the same screen, and in one block the tasks were presented to different screens (incorporating a 90° visuospatial shift mid-trial). Carry-over was found in the one-screen block, with a significantly wider horizontal search and a narrower vertical search in the pictures after a horizontal letter search. However, there was no carry-over from the letter to the picture task in the two-screen block. This indicates the flexibility of attentional control in dynamic situations, and it is suggested that persistence of attentional settings will be most costly under stable conditions.

MRI findings in movement disorders and associated sleep disturbances

BACKGROUND

One of the most useful tools for identifying sleep disturbances is neuroimaging, especially magnetic resonance imaging (MRI). This review research was to look at the role of MRI findings in movement disorders and sleep disturbances.

METHODS

This review collects all MRI data on movement disorders and sleep disruptions. Between 2000 and 2022, PubMed and Google Scholar were utilized to find original English publications and reviews. According to the inclusion and exclusion criteria, around 100 publications were included. We only looked at research that explored MRI modality together with movement problems, sleep disorders, and brain area involvement. Most of the information focuses on movement irregularities and sleep interruptions.

RESULTS

Movement disorders such as Parkinson's disease (PD), Huntington's disease (HD), neuromuscular diseases, rapid eye movement (REM) sleep behavior movement disorder (RBD), cerebellar movement disorders, and brainstem movement disorders are assessed using MRI-based neuroimaging techniques. Some of the brain areas were associated with disorders in movement abnormalities and related sleep disturbances. This review found that many people with mobility disorders also have sleep problems. Some brain areas' malfunctions may cause motor and sleep issues.

CONCLUSION

Neuroimaging helps us understand the sleep difficulties associated with movement disorders by examining the structural and functional implications of movement disorders and sleep disturbances.

Online education for prosthetics and orthotics students in the era of COVID-19 pandemic in Iran: challenges, opportunities, and recommendations

INTRODUCTION

With the advent of the COVID-19 pandemic, many higher education programs in Iran, including prosthetics and orthotics (P&O), had to shift to the online environment all at once. This unanticipated transition was challenging for the educational system. However, online education is superior in some aspects to conventional methods, and this situation may offer opportunities. This study was carried out from September 2021 to March 2022 to investigate the challenges and opportunities of online education in the P&O sector in Iran based on the opinions of students and faculty members. Relevant recommendations will also be discussed.

METHODS

In this qualitative study, semi-structured interviews were conducted in both oral and written formats. Purposive and snowball sampling techniques were used to recruit undergraduate and postgraduate P&O students, as well as P&O faculty members, for this qualitative study. The data gathered from interviews with study participants were analyzed by thematic analysis.

RESULTS

Based on the data analysis, many sub-themes of the three main themes were recognized: (1) challenges: technical, socioeconomic, environmental distractors, supervision and evaluation, workload, digital competence, interactions, motivation, sessions-related issues, class time, hands-on and clinical training; (2) opportunities: technological innovations, infrastructure development, flexible learning environment, student-centered learning, availability of contents, time and cost saving, high concentration, more self-confidence; (3) recommendations: technical infrastructure, team dynamics, hybrid courses, time management, awareness.

CONCLUSION

Online education of P&O during the era of the COVID-19 pandemic was accompanied by a series of challenges. Technical issues and the gravity of hands-on training in this field were significant challenges. This era, however, provided the opportunity to facilitate the establishment of needed infrastructure and support technological innovations for online education. Considering hybrid (mixed online and on-site) courses was recommended to improve the quality of learning.

Deterministic solution of algebraic equations in sentiment analysis

Text mining methods usually use statistical information to solve text and language-independent procedures. Text mining methods such as polarity detection based on stochastic patterns and rules need many samples to train. On the other hand, deterministic and non-probabilistic methods are easy to solve and faster than other methods but are not efficient in NLP data. In this article, a fast and efficient deterministic method for solving the problems is proposed. In the proposed method firstly we transform text and labels into a set of equations. In the second step, a mathematical solution of ill-posed equations known as Tikhonov regularization was used as a deterministic and non-probabilistic way including additional assumptions, such as smoothness of solution to assign a weight that can reflect the semantic information of each sentimental word. We confirmed the efficiency of the proposed method in the SemEval-2013 competition, ESWC Database and Taboada database as three different cases. We observed improvement of our method over negative polarity due to our proposed mathematical step. Moreover, we demonstrated the effectiveness of our proposed method over the most common and traditional machine learning, stochastic and fuzzy methods.

The quality of systematic reviews/meta-analyses assessing the effects of ankle-foot orthosis on clinical outcomes in stroke patients: A methodological systematic review

Background and Aims

Given the importance of systematic reviews (SRs) for practitioners, researchers, and policymakers, it is essential to assess them to ensure robust methodology and reliable results before applying them. The purpose of this methodological study was to assess the methodological and reporting quality of recently published SRs and/or meta-analyses (MAs) evaluating the effects of ankle-foot orthoses (AFOs) on clinical outcomes in stroke survivors.

Methods

PubMed, Scopus, Web of Science, Embase, ProQuest, CENTRAL, REHABDATA, and PEDro were searched. The research team applied A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR-2) tool and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist for evaluating the reporting and methodological quality, respectively, and the ROBIS tool was used to evaluate the risk of bias (RoB) in the included reviews. The quality of the evidence was also judged using the (Grades of Recommendation, Assessment, Development and Evaluation) GRADE method.

Results

In final, 14 SRs/MAs met inclusion criteria. Evaluation of methodological quality using the AMSTAR-2 tool demonstrated that the overall quality of included reviews was mostly "critically low" or "low," except for two studies that were "high." In addition, the findings showed that the mean score of the reporting quality of the included reviews based on the PRISMA criteria was 24.9, down from 42. In accordance with the overall evaluation applying the ROBIS tool, 14.3% of the review studies were evaluated as high RoB, 64.3% were evaluated as unclear RoB, and 21.4% were evaluated as low RoB. Regarding the level of evidence quality, the GRADE results indicated that the evidence quality of the included reviews was unsatisfactory.

Conclusion

This study showed that although the reporting quality of recently published SR/MAs evaluating the clinical effects of AFOs in stroke survivors was moderate, the methodological quality of almost all reviews was suboptimal. Therefore, reviewers must consider a number of criteria in designing, conducting, and reporting their studies to move toward transparent and conclusive results.

Educational Factors in Evidence-based Rehabilitation: A Qualitative Study in Iran

Background and Objectives: Evidence-based Practice has been shown to improve patient care and outcomes, and studies emphasize that one of the barriers to the non-use of evidence-based practice (EBP) is the lack of proper education in this area. This study aims to develop educational factors in evidence-based rehabilitation. Methods: The study was conducted using the content analysis method. The study population was the rehabilitation educators in rehabilitation schools in Iran. Purposive sampling and semi structured interviews were applied to gather the data. A total of 16 rehabilitation educators were interviewed. Data analysis was conducted using Graneheim and Lundman methods. Results: The findings of this study showed that evidence-based practice (EBP) is an educational (practical) process. Effective educational factors in evidence-based performance begin with the consideration of the needs of the patients and then look for the best methods to find the best evidence. Four themes, 10 categories, and 37 subcategories have been extracted from the study. From the analysis of the data obtained from the interviews, four main themes of “learning to find scientific evidence”, “interaction in the field of education,” “restrictive factors,” and “facilitating factors” emerged. Conclusion: Finally, they considered the triple principles of the best evidence medical education, which include the use of available scientific evidence, clinical experiences, and the client’s needs. For treatment, it integrates these parameters, and proper and timely education plays a fundamental role in this process.

Evaluating the effective pressure applied by a valgus knee orthosis in individuals with medial knee osteoarthritis based on the dose-response relationship

BACKGROUND

There is evidence that valgus knee orthosis improves clinical and biomechanical outcomes in individuals with medial knee osteoarthritis (MKOA). It is unclear whether variations in pressure application by orthosis straps can affect the biomechanical outcomes. This study aimed to determine the dose-response relationship between different orthosis straps tensions and changes in knee adduction moment (KAM) parameters in individuals with MKOA.

METHOD

Twenty-four individuals with symptomatic MKOA were enrolled in this quasi-experimental study. Five tension conditions in orthosis straps were tested in 20-mmHg increments, from 0 (no pressure) to 100 (maximal pressure) mmHg. Patients were asked to adjust the orthosis strap tension based on their perceived comfort. After each condition, a 3D gait analysis was performed, and KAM parameters were calculated. The participants also reported their satisfaction with knee orthosis adjustment for each pressure condition.

RESULTS

With successive increases in strap tension from 40 to 80 mmHg, the first peak, second peak, and angular impulse of KAM decreased nonlinearly (from 6 % to 25 %). Increasing the orthosis strap tension to 100 mmHg significantly decreased (P < 0.05) the participants' satisfaction level. The effective dosages (IC₅₀) of pressure for the first peak, second peak, and angular impulse of KAM as responses were 58, 65, and 69 mmHg, respectively.

CONCLUSION

The KAM decline was not linear as the strap pressure increased. Patients were dissatisfied with orthosis adjustment when strap tension was above 80 mmHg. The optimum dosage of pressure on the knee joint's lateral side for adjusting an orthosis' strap tension is approximately 69 mmHg.

Evaluation of User's Satisfaction With Orthotic and Prosthetic Devices and Services in Orthotics and Prosthetics Center of Iran University of Medical Sciences

BACKGROUND

The number of patients receiving orthotics and prosthetic services is increasing globally. A way to investigate patients' insight about services provided to them is to evaluate their satisfaction with the received services. Furthermore, incorporating patients' preferences into practice is an inseparable part of evidence-based practice. Applying such information in practice can contribute to the enhancement of the quality of services, the effectiveness of therapeutic interventions, and finally, the economic growth of service centers.

OBJECTIVES

To evaluate patients' satisfaction with the orthotic and prosthetic devices and services provided by the orthotics and prosthetics clinic of Iran University of Medical Sciences.

METHODOLOGY

In this study, 173 people referring to the orthotics and prosthetics clinic of Iran University of Medical Sciences were recruited, and their satisfaction level was examined using the Orthotics and Prosthetics Users' Survey questionnaire (OPUS) through a phone interview.

FINDINGS

Concerning the devices, the mean value of total satisfaction score was 74:00±19.80 and the highest score belonged to no wear or rupture of the clothes with their devices (mean value = 4.76±0.84). In terms of services, the mean value of total satisfaction score was 72.12 ± 15.90 with the highest score belonging to the politeness of the clinic staff (mean value = 4.92±0.57). When the time point from receiving service was taken into account, the patients who received the service for less than a year showed higher satisfaction level with the service (p=0.024). Although satisfaction with the device was slightly higher among the participants who used the devices for more than a year, no significant difference was observed between the two groups in terms of device satisfaction.

CONCLUSIONS

The overall satisfaction level from the devices and services was relatively high. However, the satisfaction level with the costs and coordination of the staff with the physicians showed a decline.

Translation, Cultural Adaptation, and Psychometric Evaluation of the Manchester Foot Pain and Disability Index in Persian-Speaking Iranians With Foot Disorders

Foot pain has a significantly detrimental effect on mobility, function, and health status. Researchers have developed a number of measurement tools to assess foot health and its impact on quality of life. This study was conducted to translate the original English Manchester Foot Pain and Disability Index (MFPDI) into Persian and to examine the psychometric properties of the Persian version. A total of 206 patients with a range of foot disorders filled out the Persian version of the MFPDI and the Short-Form 36 Health Survey. The Persian version of the MFPDI was re-completed by the participants at an interval of 5 to 7 days. The analyses performed included internal consistency, test-retest reliability, construct validity, and floor and ceiling effect analysis. The Persian MFPDI had a good internal consistency (Cronbach's α ≥ 0.70) and test-retest reliability (intraclass correlation coefficient = 0.84). The construct validity of the Persian MFPDI was demonstrated to be acceptable as a result of its significantly strong negative correlations with the Short-Form 36 Health Survey. The results of this study showed that the Persian version of the MFPDI is a valid and reliable measure to assess foot-related disability.

A Retrospective Study of Serum Calcium Status in Tehran, Iran (105,128 Samples, from 2009-2018)

Background: Calcium is a necessary mineral for life to keep the body and bones healthy. Various factors including hormones, diet, age, and gender affect serum calcium status. The aim of this sturdy was to assess the serum calcium level (SCL) of Tehran population, which has about 10 million multi-Ethnic populations and represents from the whole country. Methods: In this retrospective study, the measured SCL of 105,128 individuals referred to different laboratories of Tehran, Iran were evaluated and its relationship with the age, gender, seasons, and different years during 2009-2018, were analyzed. Results: After excluding outliers, 91,257samples remained, which 61162 (58.64%) and 30,095 (41.36%) were female and male, respectively.  The mean SCL was 9.36 (9.35, 9.37) mg/dl (95%CI). The highest and lowest SCLs were 3.1 and 18.2mg/dl, respectively. From the total study population, 74127 (81.23%) had normal SCLs, 14110 (15.46%) had hypocalcemia, and 3020 (3.31%) had hypercalcemia. SCLs were normal in 83.6% of men and 79.66% of women. Women had a significantly higher frequency of hypocalcemia compared to men (17.2% vs. 12.83%, p<0.0001). Conclusion: Normal and abnormal SCLs were significantly different in age groups and in both genders. It means that gender and age affect SCLs. Every year of increasing age, reduces the chance of hypercalcemia by 40%, significantly. Age seems to affect hypercalcemia more than hypocalcemia. Age in men increases the risk of hypocalcemia, and reduces the risk of hypocalcemia in women. Therefore, it is recommended to encourage dietary calcium intake among premenopausal women and older men.

Does the Extension Torque Control Differ between Injured and Uninjured Knees of ACL-Deficient Individuals?

Background: Knee extension torque control decreases after anterior cruciate ligament (ACL) rupture. There is a controversy in neuromuscular control changes on the uninvolved side. We intended to evaluate the steadiness and accuracy of quadriceps muscle control in the healthy and deficient sides of people with acute ACL rupture.

Methods: In this cross-sectional study, thirteen men with ACL rupture (age: 27.8±7.0, body mass index (BMI): 24.7±2.25: 24.7, days from injury: 48.1±21.3) participated in the study. We measured quadriceps force control, which is quantitatively assessed by the standard deviation (SD) of joint torque for a predefined submaximal target. The accuracy of muscular control or performance of quadriceps is commonly quantified by the root mean square of error (RMSE) was also measured. A two-way analysis of variance was conducted to assess SD and RMSE of two levels of quadriceps contraction (30% of muscle voluntary contraction (MVC), 50% of MVC) across both healthy and deficient knees.

Results: There was a significant main effect for SD and RMSE of MVC percentage (p<0.001). SD of quadriceps torque in 50% of MVC (1.44 ± 0.13) was higher than 30% of MVC (0.88 ± 0.1). In contrast, there was no significant main effect for SD and RMSE of knee condition.

Conclusion: After unilateral ACL rupture, the neuromuscular system becomes defected and quadriceps muscle control is then reduced in the healthy side. Therefore, the healthy side is also vulnerable to ligamentous damage. Besides, with the increasing intensity of physical activities, neuromuscular control decreases and the risk of re-injury rises.

Students' view on supportive co-teaching in medical sciences: a systematic review

BACKGROUND

Supportive co-teaching (SCT) is the practice of employing two or more experts whose knowledge and experiences are needed simultaneously to make a connection across different disciplines in a classroom. Although this interdisciplinary approach seems to be beneficial, there are many features which need further examination. This study was conducted to systematically review studies addressing the use of this approach and learners' views on SCT in medical sciences.

METHODS

We searched for the studies addressing students' views on SCT in medical sciences from January1^st 2000 to June 31st, 2019. All the studies, both quantitative and qualitative published in English language, investigating the students' views on SCT, in non-clinical courses in the setting of medical sciences were included. We searched electronic databases of PubMed, Scopus, Embase, Web of Science, WHO Global Health Library, Health Systems Evidence, and ERIC with the keywords and phrases related to the topic which were: "co-teaching", "team teaching", "collaborative teaching", "peer-to-peer co-teaching", "partnership teaching", and" teacher collaboration".

RESULTS

By the initial search, 9806 studies were found and after deletion of duplicates and screening, 111 remained for selection. Upon the independent review by two researchers, we were able to discern 12 studies eligible to be included for data extraction. All the studies reported positive views of the students towards SCT although some identified concerns and drawbacks. The students stated that they could better perceive the relationship between basic and clinical sciences, were more engaged in the learning process, and their learning experience was optimized in a course directed by SCT.

CONCLUSION

Overall, the students showed positive views of this approach of teaching, and their grades indicated they learned better than expected. However, mismatch and lack of coordination between instructors would make the class distracting, confusing and even disturbing. Further studies investigating different variables related to teachers and students in SCT classes are suggested.

Comparing Two Orthoses for Managing Medial Knee Osteoarthritis: Lateral Wedge with Subtalar Strap While Barefoot Versus Lateral Wedged Insole Fitted Within Sandal

BACKGROUND

Using foot orthoses for managing medial knee osteoarthritis (MKOA) is common, although its effectiveness is in debate. Most orthoses are placed inside the shoe as a lateral wedged insole. Thus, most studies in this area have focused on the effect of insoles used with shoes. This study compared the effects of a lateral wedge with subtalar strap (combined insole) used while barefoot and lateral wedged insole fitted within sandal on pain, function and external knee adduction moment (EKAM) in patients with MKOA to consider which orthotic treatment is better.

METHODS

In this quasi-experimental pretest-posttest study, 29 participants with medial knee osteoarthritis were divided into two groups: (1) combined insole (n = 15) and (2) sandal (n = 14) groups. We recorded their gait while walking with and without orthoses using a motion analysis system. We evaluated their pain and performance with visual analog scale, Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire, 30 s chair stand, and Timed Up and Go functional tests. The pain and performance evaluations were repeated after one month.

RESULTS

The pain immediately decreased after walking with both orthoses (p < 0.001). There was no significant difference in EKAM results between the two orthoses. Pain and performance improved in both groups after a one month using the orthoses (p < 0.01).

CONCLUSION

Both types of orthoses have similar effect and lead to better performance and less pain after 1 month.

The translation, cultural adaptation and psychometric evaluation of the Manchester Foot Pain and Disability Index in Persian-speaking Iranians with foot disorder

BACKGROUND

Foot pain has a significantly detrimental effect on mobility, function and health status. Researchers have developed a number of measurement tools to assess foot health and its impact on the quality of life. This study was conducted to translate the original English Manchester Foot Pain and Disability Index (MFPDI) into Persian and to examine the psychometric properties of the Persian version.

METHODS

A total of 206 patients with a range of foot disorders filled out the Persian version of the MFPDI and the Short-Form 36 Health Survey (SF-36). The Persian version of the MFPDI was re-completed by the participants at an interval of five to seven days. The analyses performed included internal consistency, test-retest reliability, construct validity, and floor and ceiling effect analysis.

RESULTS

The Persian MFPDI had a good internal consistency (Cronbach's α≥0.70) and test-retest reliability (ICC=0.84). The construct validity of the Persian MFPDI was demonstrated to be acceptable as a result of its significantly strong negative correlations with the SF-36.

CONCLUSION

The results of this study showed that the Persian version of the MFPDI is a valid and reliable measure to assess foot-related disability.

The relationship between common foot problems with falls and quality of life in older people

OBJECTIVES

To evaluate the relationship between a number of prevalent foot problems in older people and their history of falls and quality of life. To examine the relationship between timed up and go (TUG) test time and ankle muscles' strength.

METHOD

In this cross-sectional observational study on a convenient sample of 350 people 65 years and older, direct logistic and hierarchical regressions were used to assess the relation of self-reported falls and quality of life with hallux valgus, oedema, sensory loss and callus. The correlation coefficients were calculated to measure the relationship between TUG test time and ankle muscle strength.

RESULTS

Moderate negative correlations were measured between ankle muscles' strength and TUG time (r_Dorsiflexors  = -0.42 p = 0.000, r_{Plantar flexors}  = -0.45 p = 0.000). The odds ratio extracted from logistic regression for foot pain was 3.05 (p = 0.000, 95% CI: 1.8-5.1). The results of the hierarchical regression showed that oedema had the highest contribution to depicting the quality of life (standardised B = -0.22, p = 0.001), followed by foot pain (beta = -0.178, p = 0.004) and plantar sensory loss (beta = -0.143, p = 0.019).

CONCLUSION

The results of this study highlight the importance of foot problems in older people. Foot pain showed relationship with self-reported fall experience. Oedema and foot pain had negative impact on quality of life. Ankle muscles' strength may affect balance in older people. However, because of the small effects sizes and wide confidence intervals, the results should be interpreted cautiously.

Investigating the current status of the student evaluation system in Iran University of Medical Sciences: A step to improve education

BACKGROUND

Medical education has special features due to the need various areas of learning. The present study was conducted to provide a complete picture of the evaluation system in Iran University of Medical Sciences for improving the evaluation system and medical sciences examinations.

MATERIALS AND METHODS

The research was cross-sectional study that conducted through self-reporting of educational departments, a comprehensive review of the student evaluation system in the affiliated faculties of Iran University of Medical Sciences from 2017 to 2018. Educational members and heads of nine faculties and 80 departments participated in this study. The research tool was a researcher-made questionnaire, include two parts: (1) 10 general questions about the activities of the educational groups regarding the student evaluation system and (2) 20 questions about the types and quality of examinations.

RESULTS

From 80 questionnaires, 71 were completed by the managers of the departments. The results showed that 62% of the faculty members in the educational departments in the last 2 years did not participate in the workshop on the methods of evaluation and making tests. 56% of the faculties have a reference for continuous monitoring of students' assessment and evaluation, and in 87% of the cases, the content is given in accordance with the objectives. The use of logbooks was more common (28%) than other methods to assess practical skills.

CONCLUSION

Empower faculty members on the use of various tools, strengthening the supervision of formative evaluation and use of medical education graduates to promote evaluation methods seems necessary.

Prioritizing solutions to incorporate Prosthetics and Orthotics services into Iranian health benefits package: Using an analytic hierarchy process

INTRODUCTION

Health benefits package (HBP) is regarded as one of the main dimensions of health financing strategy. Even with increasing demands for prosthetics and orthotics (P&O) services to approximately 0.5% of the world's population, only 15% of vulnerable groups have the chance to make use of such benefits. Inadequate coverage of P&O services in the HBP is accordingly one of the leading reasons for this situation in many countries, including Iran.

AIMS

The main objective of this study was to find and prioritize solutions in order to facilitate and promote P&O services in the Iranian HBP.

STUDY DESIGN

A mixed-methods (qualitative-quantitative) research design was employed in this study.

METHODS

This study was conducted in two phases. First, semi-structured interviews were undertaken to retrieve potential solutions. Then an analytic hierarchy process (AHP) reflecting on seven criteria of acceptability, effectiveness, time, cost, feasibility, burden of disease, and fairness was performed to prioritize them.

RESULTS

In total, 26 individuals participated in semi-structured interviews and several policy solutions were proposed. Following the AHP, preventive interventions, infant-specific interventions, inpatient interventions, interventions until 6 years of age, and emergency interventions gained the highest priority to incorporate in the Iranian HBP.

CONCLUSION

A number of policy solutions were explored and prioritized for P&O services in the Iranian HBP. Our findings provide a framework for decision- and policy-makers in Iran and other countries aiming to curb the financial burdens of P&O users, especially in vulnerable groups.

Isolated carbapenem resistant bacteria, their multidrug resistant profile, percentage of healthcare associated infection and associated mortality, in hospitalized patients in a University Hospital in Bratislava

OBJECTIVES

The absence of clinical studies in Slovakia on carbapenem-resistant K. pneumoniae, A. baumannii, and P. aeruginosa, makes planning and treatment strategies challenging and less effective. Our aim is to provide new clinical data on the percentage of healthcare-associated infection, antibiotic resistance profile, and mortality risk associated with these carbapenem-resistant bacteria in our department.

METHODS

An observational, prospective, cross-sectional study was performed for a period of 15 months. Strain identification was performed after classical isolation and bio-chemical and cultivation methods. Antibiotic testing results were interpreted according to EUCAST guideline.

RESULT

Associated mortality risk was the highest in patients diagnosed with A. baumannii. The urinary tract was the most common site of isolation in all the three types of bacteria. Colistin was shown to be the most potent antibiotic among all the three types of bacteria, followed by aminoglycoside for K. pneumoniae and P. aeruginosa and ampicillin-sulbactam for A. baumannii.

CONCLUSION

A. baumannii poses the biggest challenge in the treatment and management of infected patients in our centre in Bratislava. Cephalosporins of the second to fourth generation, quinolones, tetracyclines, and cotrimoxazole are widely ineffective in the treatment of isolated bacteria. Reintroduction of colistin, despite its drug toxicity, can be considered as the last resort treatment I (Tab. 4, Fig. 4, Ref. 30).

The comparison of the effect of innovative designed storing-restoring hybrid passive AFO versus posterior leaf spring AFO on ankle joint kinematic in drop foot patients: A case series using a single subject design

Background: Drop foot syndrome is a disorder characterized by foot slapping after the initial contact and foot-dragging during the swing phase. Passive and hybrid passive ankle foot orthoses (AFOs) are often prescribed in these patients; however, the effects of these AFO designs on kinematic parameters during gait are unclear. The aim of this study was to compare the effect of innovative designed storing-restoring hybrid passive AFOs versus posterior leaf spring AFO on ankle joint kinematics in drop foot patients.

Methods: The present study was a case series where a single case and 3 cases with drop foot syndrome were recruited. This study was designed in 2 phases: the baseline phase with their PLS AFOs and an intervention phase in which innovative designed AFO were assessed. Each phase included 5 measurement sessions which were performed in 5 consecutive weeks. The celeration line method was used to detect the significant differences between the phases.

Results: The results of this study showed a significant increase in the kinematic angles parameters at the initial contact, the loading response, the mid stance, terminal stance, pre swing, initial swing, mid swing, and terminal swing with the innovative designed AFO than with PLS AFO (p<0.05).

Conclusion: The results of the present study suggested that use of the innovative designed AFO may have a positive effect on ankle joint kinematics parameters in people with drop foot.

Effects of dietary antioxidants on glucose and insulin responses to glucose tolerance test in transition dairy cows

Oxidative stress occurs during the transition period and causes insulin resistance, which may be reduced by the use of antioxidants in this period. Twenty-four multiparous Holstein dairy cows, at 8 wk before parturition, were divided into 4 equal groups, namely control (Ctrl), vitamin E (VE), selenium (Se), and vitamin E plus selenium (VE + Se) groups. On a daily basis, VE and Se cows received dietary 1.5 IU vitamin E/kg BW and 0.3 mg/kg DM selenium, respectively, from 8 wk before to 3 wk after parturition. Vitamin E plus selenium group received doses similar to VE and Se groups. Insulin sensitivity was evaluated through intravenous glucose tolerance test (ivGTT) at weekly intervals from 3 wk before to 3 wk after parturition. Serum concentrations of total antioxidant status (TAS), malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GPx), nonesterified fatty acid (NEFA), and beta-hydroxybutyric acid (BHBA) were assayed weekly before the commencement of ivGTT. Based on the results of ivGTT, the lowest and the highest degrees of insulin sensitivity were detected in Ctrl and VE + Se groups, respectively. The highest and the lowest concentrations of NEFA and BHBA were observed in Ctrl and VE + Se groups, respectively. Total antioxidant status, SOD, and GPx values were significantly lower in Ctrl cows and significantly higher in VE + Se-received cows compared with other groups. However, MDA values in Ctrl and VE + Se cows were significantly higher and lower than the other groups, respectively. Collectively, our results show that dietary administration of vitamin E and selenium ameliorates oxidative stress and lipid mobilization and increases insulin sensitivity in transition cows.

Effect of knee braces and insoles on clinical outcomes of individuals with medial knee osteoarthritis: A systematic review and meta-analysis

Knee osteoarthritis is a disabling disease, causing pain and reduced function.Orthoses are used to manage this problem, including knee braces and lateral wedge insoles. However, there is still controversy on which type of intervention is more effective. This systematic review and meta-analysis aimed toevaluate the effect of knee braces and lateral wedge insoles and compare their clinical outcomes onindividuals with medial knee osteoarthritis. We conducted the search strategy based on the population, intervention, comparison, andoutcome (PICO) method. We searched with PubMed, EMBASE, Web of Science, and Scopus databases for the related studies. The articles quality assessment was done based on the modified Downs and Black checklist. Totally, we chose 32 controlled trials, including 1.849 participants, for the final evaluation. Almosttwo-thirds of the studies had a moderate quality. The overall outcome suggested that both interventionshad improved pain and function. The difference between both interventions on pain reduction was not significant (standardized mean difference = 0.12, 95% confidence interval = 0.34 to 0.1) based on meta-analysis. Both knee brace and lateral wedge insole can improve pain and function in people with knee osteoarthritis. Using either separately or both of them together are effective.

Efficient bi-directional coupling of 3D Computational Fluid-Particle Dynamics and 1D Multiple Path Particle Dosimetry lung models for multiscale modeling of aerosol dosimetry

The development of predictive aerosol dosimetry models has been a major focus of environmental toxicology and pharmaceutical health research for decades. One-dimensional (1D) models successfully predict overall deposition averages but fail to accurately predict local deposition. Computational fluid-particle dynamics (CFPD) models provide site-specific predictions but at a computational cost that prohibits whole lung predictions. Thus, there is a need for developing multiscale strategies to provide a realistic subject-specific picture of the fate of inhaled aerosol in the lungs. CT-based 3D/CFPD models of the large airways were bidirectionally coupled with individualized 1D Navier-Stokes airflow and particle transport based upon the widely used Multiple Path Particle Dosimetry Model (MPPD). Distribution of airflows among lobes was adjusted by measured lobar volume changes observed in CT images between FRC and FRC + 1.5 L. As a test of the effectiveness of the coupling procedures, deposition modeling of previous 1 μm aerosol exposure studies was performed. The complete coupled model was run for 3 breaths, with the computation-intense portion being the 3D CFPD Lagrangian particle tracking calculation. The average deposition per breath was 11% in the combined multiscale model with site-specific doses available in the CFPD portion of the model and airway- or region-specific deposition available for the MPPD portion. In conclusion, the key methods developed in this study enable predictions of ventilation heterogeneities and aerosol deposition across the lungs that are not captured by 3D or 1D models alone. These methods can be used as the foundation for multi-scale modeling of the full respiratory system.

Ground reaction force complexity in hallux valgus

BACKGROUND

Investigating the complexity of movement systems can be insightful in clinical decision making. The study conducted to evaluate whether complexity of ground reaction force is affected by hallux valgus grades and footwear or foot side conditions.

METHODS

A sample of 120 females including 30 participants in each group of healthy and mild, moderate, and severe hallux valgus were recruited in this case-control study. Hallux valgus grades were assessed using Manchester scale. Ground reaction force were measured in bare foot and shod conditions for both feet and weighted permutation entropy was used to calculate the complexity. Nonparametric tests were employed for statistical inference.

FINDINGS

The first important result was that hallux valgus caused loss of complexity of ground reaction force with a medium to large effect size. However, we did not find any difference between three grades of hallux valgus entropy. The second finding was that entropy of healthy group decreased from barefoot to shod condition with a large effect size and the third finding was that ground reaction force entropy were similar in both feet.

INTERPRETATION

The findings are aligned with the theory that loss of complexity appears when the biological systems become functionally impaired. As soon as hallux valgus initiates, all potential risks related to the reduction of complexity appear. So, we suggest to administer conservative treatments in the early stages of hallux valgus. The study outcomes can be used for evaluation of foot function, classification of the foot types, or footwear selection.

Foot structural factors and ground reaction force in hallux valgus grades

BACKGROUND

Little attention has been paid to foot structural factors and ground reaction force in hallux valgus. Investigating the structural factors in detail and determining their biomechanical effects can help to better manage hallux valgus.

METHODS

In this case-control study, 120 females, 90 hallux valgus and 30 healthy, were recruited. Hallux valgus grades (mild, moderate, severe), first metatarsal mobility, foot pronation, hallux rotation, and pain were assessed by clinical tests. Ground reaction forces were measured in barefoot and shod conditions for both feet and analyzed using mixed within-between MANOVA. The association between structural factors and pain with force was analyzed using Spearman correlation coefficient.

RESULTS

The frequency of foot structural factors and pain severity were reported in hallux valgus grades. A significant difference was seen in the force values between groups (P<0.001). Bonferroni post hoc test indicated that the mean of the first peak for the severe group was significantly higher than the mild group (P=0.013) and the mean of second peak for the moderate group was higher than that of the healthy group (P=0.009). The force values were affected by wearing shoe (P<0.001) but not by foot side (P=0.086). There was a medium, positive correlation between the hallux rotation and force in the moderate group (r=0.39, P=0.03) and also between the pronation and force in the severe group (r=0.36, P=0.04).

CONCLUSION

Foot structural factors, pain, and force were different in each hallux valgus grads. Similar force in both feet, and increased force by wearing shoe were seen. The relationship between the pronation and hallux rotation with force revealed the importance of these factors from the biomechanical viewpoint.

The effects of counterforce brace on pain in subjects with lateral elbow tendinopathy: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Lateral elbow tendinopathy, also known as "tennis elbow" or "lateral epicondylitis," is a common disease leading to pain in the lateral side of the elbow and disability during hand gripping. A counterforce brace is one of the most conventional treatments. However, its effects on outcomes remain inconclusive.

OBJECTIVES

To investigate the effects of counterforce braces on pain in subjects with lateral elbow tendinopathy. Grip strength was reviewed as a secondary outcome.

STUDY DESIGN

Systematic review and meta-analysis of randomized controlled trials.

METHODS

PubMed, Embase, Scopus, Web of Science, CENTRAL, PEDro, ProQuest, RECAL, and RehabData were searched from January 1, 1995, through June 15, 2019.

RESULTS

Seventeen studies were included with a total of 1145 participants. A small improvement in pain over the short term (standardized mean difference -0.02; 95% confidence interval: -0.85 to 0.80) and a moderate-to-large improvement in pain in subjects 45 years or younger (standardized mean difference -0.86; 95% confidence interval: -2.45 to 0.72) in favor of the brace versus physiotherapy interventions were found. In contrast, over the long-term physiotherapy interventions (standardized mean difference 1.17; 95% confidence interval: -0.00 to 2.34), wrist splint (standardized mean difference 0.35; 95% confidence interval: -0.07 to 0.76), and laser therapy (standardized mean difference 0.58; 95% confidence interval: -0.44 to 1.59) had better effects on pain improvement versus the brace.

CONCLUSION

The results indicated that physiotherapy interventions compared to counterforce braces have better effects, especially over the long-term. However, counterforce braces may have better effects on pain in younger people (<45 years old) over the short term (<6 weeks).

CLINICAL RELEVANCE

The results suggest that counterforce bracing is a reasonable strategy to alleviate pain over the short term. However, the subgroup analysis suggests that factors such as age may have a role in their effectiveness.

Global health diplomacy: a solution to meet the needs of disabled people in Yemen

People with disabilities (PWD) are one of the most vulnerable groups in society during armed conflicts. According to the statistics, four million persons with disability live in Yemen. Lack of access and the use of rehabilitation services make PWD unable to retrieve their social and economic roles, which would have substantial negative impacts both on their families and community. The conflict escalation, an increase in the number the of displaced, COVID-19 pandemic, an increase in non-communicable diseases, and the exacerbation of poverty and malnutrition have rapidly enhanced the population at risk of disability in Yemen. Accordingly, effective and comprehensive approaches such as global health diplomacy (GHD) should be considered to meet the emerged needs. GHD seeks to address the common challenges in the global health system by involving all key stakeholders and establishing negotiations and diplomatic dialogue among official actors. Given the presence of various regional and international actors in Yemen and the examples of the successful use of GHD under conflict and post-conflict conditions in Iraq and Afghanistan, the use of diplomacy is crucial to respond to the needs of PWD in this war-torn country appropriately.

The effect of articulated AFO with hydra pneumatic damper in biomechanical characteristic of drop foot: A pilot study

Background: Ankle Foot Orthosis (AFOs) are frequently prescribed in the management of drop-foot patients. However, few studies have examined the benefits of different design of Ankle Foot Orthosis with extra elements like dampers or springs. Therefore, the objective of this study was to investigate the efficacy of articulated Ankle Foot Orthosis with Hydra pneumatic damper, in kinetic, kinematic and spatiotemporal parameters of drop foot patients. Methods: Ten drop foot patients were recruited for this study, walked at self-selected comfortable speed. A three-dimensional motion analysis, were used for obtaining kinetic, spatio-temporal and kinematic gait parameters. Results: The articulated Ankle Foot Orthosis with Hydra pneumatic damper was significantly improved speed, cadence, step length of walking (p<0.005). Furthermore, the peak and mean of moment, push off velocity and energy storing/returning were significantly improved by articulated Ankle Foot Orthosis with Hydra pneumatic damper (p<0.005). Conclusion: The newly designed articulated Ankle Foot Orthosis with Hydra pneumatic damper improved the ankle moment in at the loading response, power generation and the ankle range in drop foot patient.

Bibliometric study of traumatic brain injury rehabilitation

Purpose: This paper aims to present a bibliometric analysis of scientific documents in the field of traumatic brain injury rehabilitation.Methods: Web of Science was used to collect bibliographic data of traumatic brain injury rehabilitation documents from 1983 until the end of 2017.Results: Of a total of 6069 documents retrieved, 78.2% were journal articles. The average annual growth of the documents as of the year 2000 was 9.4%. The most frequent subject categories in this field were Rehabilitation, Neurosciences and Neurology, Sport Sciences, Psychology, and General and Internal Medicine. The most active journal was Brain Injury. More than 50% of the documents were published in 10 journals. The most prolific and impactful institutions were from the USA, Australia and Canada. Traumatic brain injury, rehabilitation, brain injury, stroke and outcome were the most commonly used keywords. Mild traumatic brain injury and concussion were the topics receiving attention in recent years.Conclusion: Traumatic brain injury rehabilitation is a young and constantly growing field. Since the late 1990s, traumatic brain injury rehabilitation documents published yearly comprised about 3-4% of all rehabilitation documents. It was shown that review papers and proceedings have more impact than journal articles, and collaborative papers receive more citations. It was also revealed that knowledge does not become obsolete rapidly in this field.

A Preliminary Report on the Largest Ongoing Outbreak of Lead Toxicity in Iran

No countrywide data exists on the patients' characteristics of lead exposure in Iran. We aimed to evaluate the demographic characteristics and blood lead level (BLL) of these patients in the country scale during five consecutive years, including the epidemic outbreak year (2016). Between 2014 and 2018, records of all patients who had referred to two reference laboratories in Tehran, Iran, to check BLL were evaluated. Of 58,642 patients, 48,589 were male. Mean age was 44.9 ± 20.7 years. Males had higher BLLs and were significantly older. Median BLL was 16 µg/dL (0.3 to 263 µg/dL). Median BLL was significantly higher in 45- to 60-year-old patients. The highest median BLL was reported in May 2016 confirming our records about the peak of the epidemic. Although the frequency of high BLL declined after 2016, it never returned to the measures before that. Considering the ongoing high prevalence of increased BLLs after 2016 and similar environmental and occupational exposures as before, lead-contaminated opium still seems to persist in the Iranian opium black market. Substitution of this lead-contaminated opium by Opioid Maintenance Therapy (OMT)-prescribed opium tincture is recommended.

Bacteria forming drag-increasing streamers on a drop implicates complementary fates of rising deep-sea oil droplets

Competing time scales involved in rapid rising micro-droplets in comparison to substantially slower biodegradation processes at oil-water interfaces highlights a perplexing question: how do biotic processes occur and alter the fates of oil micro-droplets (<500 μm) in the 400 m thick Deepwater Horizon deep-sea plume? For instance, a 200 μm droplet traverses the plume in ~48 h, while known biodegradation processes require weeks to complete. Using a microfluidic platform allowing microcosm observations of a droplet passing through a bacterial suspension at ecologically relevant length and time scales, we discover that within minutes bacteria attach onto an oil droplet and extrude polymeric streamers that rapidly bundle into an elongated aggregate, drastically increasing drag that consequently slows droplet rising velocity. Results provide a key mechanism bridging competing scales and establish a potential pathway to biodegradation and sedimentations as well as substantially alter physical transport of droplets during a deep-sea oil spill with dispersant.

Association of vitamin D, retinol and zinc deficiencies with stunting in toddlers: findings from a national study in Iran

OBJECTIVE

The objective of this study was to investigate the association of serum levels of 25(OH)D₃ (vitamin D), retinol (vitamin A) and zinc with stunting in a large sample of Iranian toddlers.

STUDY DESIGN

This was a cross-sectional study.

METHODS

A total of 4261 children, aged 10-36 months, who had Iranian birth certificates were included in the present study. Weight and height were measured by experienced professionals in accordance with standard protocols. Stunting was defined as a height-for-age z-score of <-1 standard deviation (SD) based on the World Health Organization (WHO) criteria (the WHO Child Growth Standards median). Serum levels of 25(OH)D₃, retinol and zinc were examined based on standard methods.

RESULTS

The mean age of the study participants was 19.2 ± 8.4 months. A significant inverse association was found between serum retinol concentrations and the odds of stunting such that after controlling for potential confounders, toddlers in the highest quartile of serum retinol levels had 29% lower odds of stunting than those in the lowest quartile (odds ratio [OR]: 0.71, 95% confidence interval [CI]: 0.53-0.97). Furthermore, a significant inverse association was found between serum levels of retinol and stunting in girls (OR: 0.57, 95% CI: 0.34-0.94), urban toddlers (OR: 0.66, 95% CI: 0.44-0.99) and those who did not use nutritional supplements (OR: 0.70, 95% CI: 0.52-0.95). Although serum 25(OH)D₃ levels were not significantly associated with stunting in the overall study population, we found a positive association among toddlers who used nutritional supplements. No significant association was found between serum levels of zinc and stunting.

CONCLUSION

We found a significant inverse association between serum levels of retinol and stunting in toddlers aged 10-36 months.

The effects of ankle-foot orthoses on walking speed in patients with stroke: a systematic review and meta-analysis of randomized controlled trials

Objective:

The aim of this study was to evaluate the effects of ankle-foot orthoses on speed walking in patients with stroke.

Data sources:

PubMed, Embase, Web of Science, Scopus, CENTRAL, PEDro, RehabData, RECAL, and ProQuest were searched from inception until 30 September 2019.

Review methods:

This study was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline statement. Risk of bias assessment was performed using the Cochrane Risk of Bias Tool. Begg’s test and Egger’s regression method were used to assess the publication bias. Trim and fill analysis was also used to adjust any potential publication bias. Sensitivity analysis was performed to evaluate the effect of individual studies. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria.

Results:

Overall, 14 studies were included with a total of 1186 participants. A small-to-moderate and non-significant improvement in favor of the ankle-foot orthosis versus without ankle-foot orthosis (standardized mean difference (SMD) = 0.41, 95% confidence interval = −0.15 to 0.96), similar effects of ankle-foot orthosis and functional electrical stimulation (SMD = 0.00, 95% confidence interval = −0.16 to 0.16), and a small and non-significant improvement in favor of ankle-foot orthosis versus another type of ankle-foot orthosis (SMD = 0.22, 95% confidence interval = −0.05 to 0.49) in walking speed were found. However, the quality of evidence for all comparisons was low or very low.

Conclusion:

Despite reported positive effects in some studies, there is no firm evidence of any benefit of ankle-foot orthoses on walking speed.

A new ecology-on-a-chip microfluidic platform to study interactions of microbes with a rising oil droplet

Advances in microfluidics technology has enabled many discoveries on microbial mechanisms and phenotypes owing to its exquisite controls over biological and chemical environments. However, emulating accurate ecologically relevant flow environments (e.g. microbes around a rising oil droplet) in microfluidics remains challenging. Here, we present a microfluidic platform, i.e. ecology-on-a-chip (eChip), that simulates environmental conditions around an oil droplet rising through ocean water as commonly occurred during a deep-sea oil spill or a natural seep, and enables detailed observations of microbe-oil interactions at scales relevant to marine ecology (i.e. spatial scales of individual bacterium in a dense suspension and temporal scales from milliseconds to weeks or months). Owing to the unique capabilities, we present unprecedented observations of polymeric microbial aggregates formed on rising oil droplets and their associated hydrodynamic impacts including flow fields and momentum budgets. Using the platform with Pseudomonas, Marinobacter, and Alcarnivorax, we have shown that polymeric aggregates formed by them present significant differences in morphology, growth rates, and hydrodynamic impacts. This platform enables us to investigate unexplored array of microbial interactions with oil drops.

The Effect of Bracing on Spinopelvic Rotation and Psychosocial Parameters in Adolescents with Idiopathic Scoliosis

Study Design

Retrospective study.

Purpose

To evaluate the effect of bracing on spinopelvic rotation and psychosocial parameters in adolescents with idiopathic scoliosis (AIS).

Overview of Literature

Complex three-dimensional deformity in AIS is proposed to influence the spinopelvic parameters and psychosocial condition in adolescents; however, few studies have quantitatively evaluated these parameters.

Methods

Thirty AIS who were prescribed a brace were included in the study. The patients’ standing postero-anterior and total spine radiographs were used to measure the primary curve Cobb angle, vertebral rotation, and pelvic rotation. Apical vertebral rotation (AVR), upper AVR, and lower AVR were measured using the Nash-Moe method. Pelvic rotation was determined using the left-to-right hemipelvic width ratio. The curve pattern was classified as per the Lenke classification system. In all, 14 patients had a type I curve, five had type II, six had type III, one had type IV, and four had type V curves. Brace compliance was subjectively evaluated by interviewing the patients and their parents. The health-related quality of life (HRQOL) and stress level of the recruited patients were assessed using the Brace Questionnaire and Bad Sobernheim Stress Questionnaire, respectively.

Results

The Cobb angle significantly decreased with at least 6 months of brace use. AVR correction changed significantly; however, no such results were observed for upper and lower AVR. Pelvic rotation and psychosocial parameters were not significantly affected by brace use. No statistically significant correlation was observed between brace compliance and curve correction.

Conclusions

The Cobb angle and AVR are crucial measurements that help evaluate the treatment efficacy in AIS with small curves who undergo brace treatment. HRQOL and pelvic axial rotation are not influenced by the brace treatment.

Reliability and Concurrent Validity of a Culturally Adapted Persian Version of the Brace Questionnaire in Adolescents With Idiopathic Scoliosis

STUDY DESIGN

Cross-sectional.

OBJECTIVES

To determine the validity and reliability of culturally adapted Persian version of the Brace Questionnaire (P-BrQ).

SUMMARY OF BACKGROUND DATA

The BrQ has proved to be a reliable and valid instrument for evaluating the quality of life of adolescents with idiopathic scoliosis and has been translated to different languages. But, lack of a Persian translated version makes its use impractical in the Persian speaking scoliotic patients.

METHODS

Forward and backward translation of P-BrQ was conducted according to the International Quality of Life Assessment guidelines. The final version of the P-BrQ was administered to 51 adolescents (1 boy and 50 girls) with idiopathic scoliosis. The mean age of the participants was 13.88 ± 2.14 years. The questionnaire's internal consistency was determined using Cronbach's alpha. A subgroup of 38 participants were randomly selected to complete the BrQ for a second time one week later. The test-retest reliability was then analyzed using the intraclass correlation coefficient, while the concurrent validity was assessed by comparing the BrQ with the Scoliosis Research Society-22 questionnaire.

RESULTS

The total Cronbach's alpha coefficient of the P-BrQ was 0.96, and the overall intraclass correlation coefficient of the questionnaire was also 0.96. The intraclass correlation coefficients for the corresponding domains were as follows: general health perception, 0.96; physical functioning, 0.96; emotional functioning, 0.98; self-esteem, 0.80; vitality, 0.97; school activity, 0.98; pain, 0.97; and social functioning, 0.98.

CONCLUSIONS

The culturally adapted Persian version of the BrQ can be used to assess the quality of life of adolescents with idiopathic scoliosis who wear a brace.

LEVEL OF EVIDENCE

II.

The effect of hydrodynamic insole on foot kinematics in individuals with flexible flatfoot: Case series using a single-subject design

The medial longitudinal arch of the foot is a dynamic structure while walking. The mobility of this structure in people with flexible flatfoot is partially or completely absent. The aim of this study was to investigate the efficacy of an insole that was designed to retrieve the medial longitudinal arch mobility in people with flatfoot. The study was a case series using a single-subject design. This single-subject design study was based on three subjects with flexible flatfoot. This study was designed in two phases: the baseline phase and the intervention phase. Each phase included five measurement sessions that were done in 5 consecutive weeks. We used the celeration-line method to detect the significant differences between the phases. Significant differences were recorded in the walking velocity, step length, and medial longitudinal arch mobility parameters when using the hydrodynamic insole. The results of this study showed that using the hydrodynamic insole may have a positive effect on the foot kinematics and gait parameters in people with flexible flatfoot.

The effect of functional bracing on the arthrokinematics of anterior cruciate ligament injured knees during lunge exercise

BACKGROUND

Functional knee braces are extensively used for partially and completely torn anterior cruciate ligament (ACL) patients and those who have undergone ACL graft reconstruction, in order to support the healing ACL, improve the joint's functional stability, and restore the normal joint kinematics.

RESEARCH QUESTION

Does wearing braces alter the arthrokinematics of the ACL deficient knees during lung exercise?

METHODS

For ten male unilateral ACL deficient subjects, 3D knee models were reconstructed from CT images, acquired in rest position. Sagittal plane fluoroscopy was then performed throughout a complete cycle of lunge in braced and non-braced conditions. The 3D kinematics of the knees were obtained using a 2D-3D registration method in which six anatomical bony landmarks on the fluoroscopic images were matched with those on the 3D models.

RESULTS

No significant difference was found between the tibial anterior-posterior translations and abduction-adduction motions of the braced and non-braced knees. A significant decrease, however, was observed after bracing in the tibial internal rotation at 45° flexion during eccentric (non-braced: 5.9° (±6.7°) vs. braced: 2.4° (±7.0°); p = 0.045), and at 30° flexion during concentric (non-braced: 2.3° (±6.9°) vs. braced: -1.6° (±8.1°); p = 0.001) phases of the lunge cycle.

SIGNIFICANCE

The immediate effect of knee bracing is limited to controlling the tibial rotation of the ACL deficient individuals during the lunge exercise. Hence, care should be taken in prescribing the lunge exercise for rehabilitation of ACL injured patients with high anterior-posterior knee instability, even when wearing knee braces.

Fabrication and characterization of a scalable surface textured with pico-liter oil drops for mechanistic studies of bacteria-oil interactions

Texturing a large surface with oily micro-drops with controlled size, shape and volume provides an unprecedented capability in investigating complex interactions of bacteria, cells and interfaces. It has particular implications in understanding key microbial processes involved in remediation of environmental disasters, such as Deepwater Horizon oil spill. This work presents a development of scalable micro-transfer molding to functionalize a substrate with oily drop array to generate a microcosm mimicking bacteria encountering a rising droplet cloud. The volume of each drop within a large “printed” surface can be tuned by varying base geometry and area with characteristic scales from 5 to 50 μm. Contrary to macroscopic counterparts, drops with non-Laplacian shapes, i.e. sharp corners, that appears to violate Young-Laplacian relationship locally, are produced. Although the drop relaxes into a spherical cap with constant mean curvature, the contact line with sharp corners remains pinned. Relaxation times from initial to asymptotic shape require extraordinarily long time (>7 days). We demonstrate that non-Laplacian drops are the direct results of self-pinning of contact line by nanoparticles in the oil. This technique has been applied to study biofilm formation at the oil-water interface and can be readily extended to other colloidal fluids.

Effects of unstable footwear on gait characteristic: A systematic review

BACKGROUND

Over the last three decades, several designs of unstable footwear have been developed in the forms of shoes, sandals and boots. There are marketing claims related to the positive effects of these shoes on the training of lower limb muscles and improving gait. Many studies have been performed on the effects of unstable footwear on muscle activity, balance, posture, energy expenditure, lower extremity disorders, and biomechanical changes. The analysis of the kinetics and kinematics characteristics of gait would provide objective representation of body movement.

OBJECTIVE

To systematically review available evidence on the use of unstable footwear on kinetic and kinematic parameters to make specific recommendation for practice and future studies.

METHOD

A computer-based search was undertaken through PubMed, Cochrane Library, Embase, PEDro, Web of Science and Google Scholar from 2005 to 2015. The included studies were appraised using McMaster Critical Review Form for Quantitative Studies.

RESULT

Ten studies (quasi-experimental design) were included.

CONCLUSION

Considering kinetic and kinematic interaction of variables in the included studies revealed that confounding factors may have high impact on biomechanical findings of unstable footwear. Then, more homogeneous studies, considering these factors, should be implemented in future studies to inform the best clinical practice.

Comparison of the fecal bacterial microbiota of healthy and diarrheic foals at two and four weeks of life

BACKGROUND

Diarrhea in foals affects up to 60% of foals during the first six months of life. The effect of diarrhea on the fecal bacterial microbiota in foals has not been investigated. Little is known on the fecal bacterial microbial richness and diversity of foals at a young age. The objective was to compare the fecal bacterial microbiota of healthy foals to foals with diarrhea at two and four weeks of life.

METHODS

Fecal samples were collected from foals (n = 20) at 1-14 (T1) and 15-28 (T2) days of age and analyzed using high throughput sequencing. Differences in relative abundance of bacterial taxa, alpha diversity and beta diversity indices were assessed between age-matched foals with diarrhea (n = 9) and healthy foals (n = 11), and between time points.

RESULTS

Differences in microbial community composition based on time point and health status were observed on all taxonomic levels. Of 117 enriched species in healthy foals at T2, 50 (48%) were Lachnospiraceae or Ruminococcaceae. The Chao richness index was increased in healthy foals at T2 compared to T1 (p = 0.02). Foals with diarrhea had a significantly lower richness index than non-diarrheic foals at T2 (p = 0.04). Diarrhea had an inconsistent effect, while time point had a consistent effect on microbial community structure.

CONCLUSIONS

Preventative and therapeutic measures for diarrhea should focus on maintaining bacterial microbiota richness. Lachnospiraceae and Ruminococcaceae were underrepresented in foals with diarrhea. These should be evaluated further as potential therapeutic options.

Optimal Path Planning of Spatial Cable Robot Using Optimal Sliding Mode Control

This paper proposes a control strategy for a cable-suspended robot based on an optimal sliding mode approach confronted by external disturbances and parametric uncertainties. This control algorithm is based on the Lyapunov technique, which is not only able to provide the stability of the end-effector with an acceptable precision but also provides the optimal path in which the maximum load can be carried along. In addition, the optimization of the robot is performed based on an optimal sliding mode (SMC) approach. Tracking a predefined trajectory, path planning and the calculation of its relevant Dynamic Load Carrying Capacity (DLCC) is done based on the motors' torque and accuracy constraints. Optimal SMC, as a robust control algorithm, is used for controlling the stability of the system, while the Linear Quadratic Regulator (LQR) optimization tool is employed in order to optimize the controller gains. The main contribution of the paper is in calculating the DLCC of the cable robot. Finally, the efficiency of the proposed method is illustrated by performing some simulation studies on the ICaSbot (IUST Cable-suspended Robot), which supports six DOFs using six actuating cables, and experimental results confirm the validity of the authors' claim.