Moulodi, N.,
Sarrafzadeh, J.,
Azadinia, F.,
Shakourirad, A.,
Jalali, M. Physiotherapy Theory and Practice (15325040)41(1)pp. 44-53
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. © 2024 Taylor & Francis Group, LLC.
PLoS ONE (19326203)20(7 July)
Purpose Quality of life is a crucial outcome in evaluating adjustment to prostheses for individuals with non-traumatic lower limb amputation (LLA). This study aimed to identify prostheses-related factors that predict the quality of life in people with non-traumatic, unilateral, transtibial amputation. Materials and methods This cross-sectional study surveyed 168 people who have experienced nontraumatic, unilateral, transtibial amputations and use prosthesis. They completed the 12-item short-form (SF-12) health survey and the comprehensive lower limb amputee socket survey (CLASS). We did correlation analyses to explore relationships between the variables and quality of life, followed by multiple regression analyses to assess their impact on quality of life outcomes. Results Quality of life had a strong positive association with comfort (r = 0.65, p = 0.001). There was a moderate positive association with socket stability (r = 0.46, p < 0.001) and suspension (r = 0.48, p = 0.001), as well as a weak positive association with appearance (r = 0.35, p = 0.001). In the final regression model, the comfort subscale of CLASS was the strongest predictor of quality of life (β = 0.51, p = 0.001). Conclusion This study highlights that prosthesis socket comfort is the primary prosthesis-related factor predicting the quality of life for individuals with non-traumatic, unilateral, transtibial amputation. Thus, rehabilitation should prioritize modifiable factors, especially optimal socket fitting. Identifying user needs is essential for better prosthesis use, as enhancements in other prosthetic components do not necessarily improve quality of life without considering socket comfort. © 2025 Alavi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Nabizadeh, S.,
Jalali, M.,
Kamali, M.,
Shahabi, S.,
Babaee, T. Prosthetics and Orthotics International (17461553)48(2)pp. 230-239
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. © 2023 International Society for Prosthetics and Orthotics.
Medical Journal Of The Islamic Republic Of Iran (22516840)38(1)pp. 102-102
Background: Limb loss can negatively affect the psychological and physical well-being, mobility, and social life of people with lower limb amputation. Participating in physical activities is of great importance for these people. This study aimed to explore factors affecting the physical activity of Iraqi lower-limb amputees. Methods: In this cross-sectional study, the participants were asked to fill out the Oswestry disability index (ODI) questionnaire, the 12-item short-form health survey (SF-12), the Trinity Amputation and Prosthesis Experience Scales (TAPES), and the International Physical Activity Questionnaire (IPAQ). The performance-based Timed Up and Go (TUG) test was also assessed. We used a hierarchical regression model to estimate the effect of some parameters on physical activity considering age, sex, and level of amputation. Results: A total of 376 lower limb amputees, aged 20 to 67 years old, completed the tests. The TUG time (beta = 0.406; P < 0.001), mental component score of the SF-12 (beta = 0.214; P < 0.001), ODI (beta = –0.201; P < 0.001), and physical activity component of SF-12 (beta = 0.131; P = 0.002) had significant associations with physical activity. Conclusion: The TUG time was the most critical factor in predicting physical activity. The mental score component of the SF-12 ranked second, showing the importance of family and social support for amputees in their physical activity and emphasizing the importance of including mental and psychosocial plans in the rehabilitation program of lower limb amputees. Low back pain should be taken seriously in lower limb amputees because of its prevalence and the effect of its related disability on the physical activity of amputees. Residual limb pain was also very prevalent. Although it did not contribute to our model, its negative effect on physical activity should not be underestimated. © Iran University of Medical Sciences
Chami, S.,
Babaee, T.,
Jalali, M.,
Saeedi, H.,
Kamali, M. Prosthetics and Orthotics International (17461553)48(3)pp. 320-328
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. Copyright © 2023 International Society for Prosthetics and Orthotics.
Jiryaei, Z.,
Amini, M.,
Sanjari, M.A.,
Hajiaghaei, B.,
Babazadeh, R.,
Jalali, M. Prosthetics and Orthotics International (17461553)48(4)pp. 387-399
Background: Hinged ankle foot orthoses (HAFO) are commonly prescribed for children with cerebral palsy (CP) to improve their ambulatory function. Objectives: The aim of this study was to compare the effect of vibration-HAFO with that of the same orthosis without vibration on gait, function, and spasticity in hemiplegic CP children. Study Design: Randomized Control Trial Design (a pilot study). Methods: Twenty-three children with hemiplegic CP participated in this study. The control group (n 5 12) used HAFO, and the intervention group (n 5 11) used vibration-HAFO for four weeks. Pre-post three-dimensional gait analysis was done. Calf muscle spasticity and function were also measured. Results: Results showed significant differences between the two groups in the one-minute walking test (p 5 0.023) and spasticity (after intervention [p 5 0.022], after follow-up [p 5 0.020]). Also, significant differences were detected between the two groups in the step width (p 5 0.042), maximum hip abduction (p 5 0.008), stance maximum dorsiflexion (p 5 0.036) and mean pelvic tilt (p 5 0.004) in the barefoot condition. Gait cycle time (p 5 0.005), maximum hip abduction (p 5 0.042), and cadence (p 5 0.001) were different between groups in the braced condition. We couldn’t find any significant within and between groups differences in knee kinematic parameters. The mean time of using vibration was 16.83 minutes per day. Conclusions: The vibration-hinged AFO is feasible, safe, and acceptable for children with hemiplegic CP to be integrated into practice. Temporospatial and clinical parameters, especially spasticity, were improved. There were slight trends toward improvement in pelvic and knee kinematics. Vibration-HAFO is of benefit to ambulatory CP children with mild and moderate spasticity. It improved the walking capacity of the children. Copyright © 2023 International Society for Prosthetics and Orthotics.
Shahabi, S.,
Mcdonald, C.L.,
Jalali, M.,
Lankarani, K.B.,
Joulaei, H.,
Behzadifar, M.,
Mojgani, P. Disability and Rehabilitation (09638288)45(24)pp. 4133-4147
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 rehabilitation Lack 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. © 2022 Informa UK Limited, trading as Taylor & Francis Group.
Khosravi, M.,
Jalali, M.,
Babaee, T.,
Sanjari, M.A.,
Rahimi, A. Knee (18735800)40pp. 174-182
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. © 2022 Elsevier B.V.
Jalali, M.,
Moradi, V.,
Babaee, T.,
Aminian, G.,
Mojgani, P.,
Shahabi, S. BMC Medical Education (14726920)23(1)
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. © 2023, The Author(s).
Shahabi, S.,
Mojgani, P.,
Lankarani, K.B.,
Jalali, M. Health Science Reports (23988835)6(3)
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. © 2023 The Authors. Health Science Reports published by Wiley Periodicals LLC.
Neuropsychological Rehabilitation (14640694)32(1)pp. 51-68
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. © 2020 Informa UK Limited, trading as Taylor & Francis Group.
Falahatgar, M.,
Jalali, M.,
Babaee, T.,
Safaeepour, Z.,
Torkaman, A.,
Baniasad, M. Indian Journal of Orthopaedics (19983727)56(2)pp. 319-326
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. © 2021, Indian Orthopaedics Association.
Medical Journal Of The Islamic Republic Of Iran (22516840)36(1)
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. © 2022 Iran University of Medical Sciences. All Rights Reserved.
Khosravi, M.,
Babaee, T.,
Daryabor, A.,
Jalali, M. Assistive Technology (19493614)34(5)pp. 501-517
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. © 2021 RESNA.
Baghbanbashi, A.,
Farahmand, B.,
Azadinia, F.,
Jalali, M. Canadian Prosthetics and Orthotics Journal (2561987X)5(1)
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. OBJECTIVE(S): 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. © 2022 University of Osijek - Faculty of Humanities and Social Sciences. All rights reserved.
Moulodi, N.,
Jalali, M.,
Sarrafzadeh, J.,
Azadinia, F.,
Shakourirad, A. Iranian Journal Of Radiology (20082711)19(3)
Background: The muscle volume considerably changes with aging, pathologies, mechanical loading and exercise, and immobilization. It is recognized as an important parameter that can be measured by various methods to evaluate the effectiveness of interventions focusing on muscle strengthening and function. However, before the application of any measurement method, their reliability needs to be investigated and established. Objectives: This study aimed to evaluate the inter- and intra-rater reliability of the manual measurement method of the abductor hallucis muscle volume in feet with hallux valgus deformities using magnetic resonance imaging (MRI). Patients and Methods: The MRI images of the feet of 15 samples with a hallux valgus deformity were selected in this study. The cross-sectional areas of the abductor hallucis muscle were measured in the cuts along the entire length of the foot and multiplied by slice thickness. Two trained raters performed the measurements. The second rater repeated the measurements after five days to eliminate the memory effect. The intra-rater reliability and inter-rater reliability were assessed based on the intraclass correlation coefficient [ICC (2, 1)] to evaluate the extent of agreement between the raters at a 95% confidence interval. Results: The between- and within-rater ICCs were 0.92 (0.79-0.97) and 0.99 (0.97-0.99), respectively. The standard error of measurements was also small in both inter-rater (6.2%) and intra-rater (2.1%) reliability analyses. Conclusion: The manually outlined slice-by-slice volume measurement of the abductor hallucis muscle based on MRI images showed excellent inter- and intra-rater reliability. The excellent intra-rater reliability, besides the lower standard error percentage of measurements, indicates the superiority of measurements by a single person. However, further studies with a larger sample size are recommended. © 2022, Author(s).
Esfandiari, E.,
Saeedi, H.,
Ahmadi, A.,
Jalali, M.,
Mohammad pour, A.,
Abdollah, V. Foot (09582592)50
Background: Adopting compensatory walking mechanisms by people with foot drop due to traumatic injury of the peroneal nerve costs altered gait kinetics and kinematics. Therefore, orthoses are generally recommended to minimize the deployment of compensatory gait mechanisms. Objectives: To investigate the immediate effects of a low-cost, Neoprene Ankle-Foot Orthosis (NAFO) and the thermoplastic ankle-foot orthosis (AFO) with the shoe-only condition on kinematics and kinetics of gait of people with foot drop following peroneal nerve traumatic injury. Methods: Seven people with foot drop due to traumatic injury of the peroneal nerve were included in this study. The gait kinematics and kinetics of the participants were investigated in three different conditions: shoe-only, AFO + shoe, and NAFO + shoe using a six-camera, motion-analysis system, and a force platform. A Friedman two-way ANOVA by ranks model was employed to compare different testing conditions. Results: The ankle angle at the initial contact was significantly different between shoe-only condition and AFO (p < 0.00). The plantarflexion angle in both orthotic designs was reduced significantly compared to the shoe-only condition (p < 0.00). The maximum ankle dorsiflexion angle during the stance phase and maximum knee flexion angle during the stance and swing phases were not statistically significant for all testing conditions (p > 0.00). A significant difference was observed for the 1st-rise of the ground reaction force's vertical component between the NAFO and the AFO (p < 0.00). Likewise, a significant difference was observed for the 2nd-rise of the ground reaction force's vertical component between the NAFB and the AFO (p < 0.00). Conclusion: Both orthotic interventions could control the ankle-foot complex during the gait and reduce the employment of compensatory gait mechanisms. © 2021 Elsevier Ltd
Iranian Rehabilitation Journal (17353602)20(1)pp. 61-72
Objectives: The main objective of this study was to culturally adapt the original English version of the Physical Activity Scale For Individuals with Physical Disabilities (PASIPD) for the Persian-speaking patients with Lower-Limb Amputations (LLAs) and to evaluate its reliability and construct validity. Methods: This research was a multicenter cross-sectional and repeated measure study. The cultural adaptation process was conducted according to an accepted international guideline. A total of 197 Persian-speaking individuals with LLA were recruited to investigate the reliability and validity of the PASIPD. Reliability analyses were assessed by Cronbach α and the Pearson product-moment correlation coefficient. The Association between the PASIPD scores and the prosthetic limb user survey of mobility scores was examined to evaluate the convergent validity of the PASIPD. Known-groups validity was assessed based on sex, amputation causes, and amputation levels. Results: The PASIPD had an acceptable internal uniformity (the Cronbach α of 0.68) and test-retest reproducibility (r=0.70). There was a small correlation between the PASIPD and prosthetic limb user mobility survey (r=0.26; P<0.001). Some items of PASIPD could discriminate individuals with different causes of amputation and sex. Factor analysis extracted four main factors that explained 65.4% of the variance. Discussion: The Persian version of the PASIPD has acceptable reliability and validity for assessing the physical activity of persons with LLAs © 2022. Iranian Rehabilitation Journal.All Rights Reserved.
Saeedi, H.,
Azadinia, F.,
Jalali, M.,
Bagheripour, B.,
Ronasi, P.,
Ershadi, F.S. Footwear Science (19424280)14(1)pp. 14-21
Although shoes act as a protective covering for the feet, they can be an important source of pain and foot disorder if not properly fitted. The purpose of this study was to investigate the effect of a shoe with highly compliant upper on the dorsal digital and interdigital pressure in comparison with shoes with a rounded toe box and participant’s own shoes in patients with Hallux Abducto Valgus (HAV) deformity. Eighteen participants with moderate to severe HAV were recruited. The patients’ perceived comfort and interdigital forefoot pressure were measured using force sensitive resistance sensors while wearing shoes with a round toe box and shoes with stretchable fabric upper and were compared to when the participants were wearing their own preferred shoes. Shoes with stretchable fabric upper significantly reduced the dorsal digital and interdigital pressure and increased perceived comfort. The results of the present study showed the superiority of shoes with stretchable fabric upper in reducing the pressure on the forefoot and the overall comfort compared to shoes with a round toe box and participant’s own shoes in people with HAV. It, therefore, seems that shoes with stretchable fabric upper can be recommended to ameliorate the treatment outcome in people with HAV. © 2021 Informa UK Limited, trading as Taylor & Francis Group.
Babaee, T.,
Esfandiari, E.,
Rouhani, N.,
Nakhaee, M.,
Saeedi, M.,
Hedayati, Z.,
Jalali, M.,
Moradi, V. Spine Deformity (22121358)10(4)pp. 775-782
Purpose: To assess the reliability and validity of the Persian version of the Italian Spine Youth Quality of Life (P-ISYQOL) questionnaire. Methods: Forward/backward translations and cultural adaption processes of the ISYQOL questionnaire into Persian were conducted by an expert committee. We recruited 178 adolescents with idiopathic scoliosis (AIS) and Scheuermann’s kyphosis (SK) and 103 age-matched adolescents with no spinal deformity. Reliability was assessed by evaluating internal consistency and test–retest reliability using Cronbach’s alpha and intraclass correlation coefficient (ICC). Convergent construct validity was assessed by measuring the association between the ISYQOL and revised 22-item Scoliosis Research Society (SRS-22r) questionnaires scores. Known-groups construct validity was assessed regarding curve magnitude, deformity, age, sex, and treatment type. Results: Cronbach’s alpha and ICC for P-ISYQOL total score was 0.8 and 0.9, respectively. An acceptable association was observed between P-ISYQOL and SRS-22r total scores (r = − 0.5, p < 0.01). The P-ISYQOL could discriminate between adolescents with spinal deformities and adolescents with no spinal deformity as well as those with different types of deformity and treatment (p < 0.01). Conclusions: The P-ISYQOL is a reliable and valid survey to assess the outcomes of adolescents with spinal deformities. Level of evidence: Level I—diagnostic studies. © 2022, The Author(s), under exclusive licence to Scoliosis Research Society.
Azadinia, F.,
Saeedi, H.,
Poorpooneh, M.,
Moulodi, N.,
Jalali, M. Journal of Foot and Ankle Surgery (15422224)61(4)pp. 867-871
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. © 2021 the American College of Foot and Ankle Surgeons
Farzadi, M.,
Sanjari, M.A.,
Jalali, M.,
Saeedi, H.,
Kamali, M.,
Movahedi yeganeh, M. Clinical Biomechanics (18791271)81
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. © 2020
Maroufi, S.S.,
Moradimajd, P.,
Jalali, M.,
Ramezani, G.,
Alizadeh, S. Journal of Education and Health Promotion (22779531)10(1)
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. © 2021 Journal of Education and Health Promotion.
Shahabi, S.,
Skempes, D.,
Pardhan, S.,
Jalali, M.,
Mojgani, P.,
Lankarani, K.B. Disability and Society (13600508)36(3)pp. 508-512
The Syrian civil war, which initiated in 2011, has been one of the most devastating conflicts of recent decades. Based on the World Health Organization and Handicap International 2017 report, about 3 million people are injured and living with disabilities in Syria, which about half of them have permanent disabilities including 86,000 amputees. More importantly, approximately 30,000 people are added to the disabled in Syria every month. In response, various international organizations and NGOs have developed initiatives and established programmes to increase access to rehabilitation services for people with disabilities in Syria and other regions where refugees live. However, further effective policies are needed to address the needs of disabled people in this Warn-torn country. © 2021 Informa UK Limited, trading as Taylor & Francis Group.
Shahabi, S.,
Pardhan, S.,
Teymourlouy, A.A.,
Skempes, D.,
Shahali, S.,
Mojgani, P.,
Jalali, M.,
Lankarani, K.B. PLoS ONE (19326203)16(6 June)
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. © 2021 Shahabi et al.
Bidari, S.,
Jalali, M.,
Kamali, M.,
Bagheripour, B. Iranian Rehabilitation Journal (17353602)19(1)pp. 59-67
Objectives: Foot disorders, especially pain and deformities, are common patient complaints. Foot Health Status Questionnaire (FHSQ) was developed to assess general and foot health specifically in chronic foot disorders. The purpose of the current study was the cross-cultural adaptation of the FHSQ to Persian and evaluating the psychometric properties of the translated version. Methods: As per the International Quality of Life Assessment guideline, the forward and backward translations of the questionnaire were conducted by two independent translators. Accordingly, the final version was approved by a committee and confirmed by the developer. The psychometric properties of the Persian version of the FHSQ were tested in 101 participants (Mean±SD age: 42.98±15.03 y) with chronic foot disorders. Face validity by impact score calculation; criterion validity through correlation to the Manchester-Oxford Foot Questionnaire (MOXFQ) scores; internal consistency by Cronbach’s alpha coefficient, and test-retest reliability by calculating intra-class correlation were tested to describe the psychometric features of its Persian version. Results: Face validity was confirmed by impact scores of >1.5 for all items. The FHSQ was significantly correlated with the MOXFQ domains, supporting the criterion validity of the instrument, except for the shoe domain of the Persian FHSQ, i.e., not correlated with the pain domain of the MOXFQ (r=0.26). Cronbach’s alpha coefficients for pain, function, shoe, and general foot health were measured as 0.93, 0.92, 0.90, and 0.96 respectively. Thus, it suggested an excellent internal consistency for all domains. The intra-class correlation coefficient ranged from 0.73 to 0.93 for all domains, reflecting its good to excellent reliability. Discussion: The Persian version of the FHSQ is a valid and reliable patient satisfaction measurement instrument for evaluating foot conditions. Moreover, the current study results supported the potential of applying it as an appropriate instrument in research and clinical setting. Implementing this tool could help to evaluate the effects of an intervention or estimate the prevalence of a disorder in Persian-speaking populations. © 2021. All Rights Reserved.
Dehnad, A.,
Jalali, M.,
Shahabi, S.,
Mojgani, P.,
Bigdeli, S. BMC Medical Education (14726920)21(1)
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 January1st 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. © 2021, The Author(s).
Jalali, M.,
Mojgani, P.,
Saeedi, H.,
Azadinia, F.,
Niksolat, M.,
Ghorbani, F. International Journal of Older People Nursing (17483735)16(6)
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 (rDorsiflexors = −0.42 p = 0.000, rPlantar 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. © 2021 John Wiley & Sons Ltd
Azadinia, F.,
Saeedi, H.,
Poorpooneh, M.,
Mouloodi, N.,
Jalali, M. Foot and Ankle Surgery (14609584)27(6)pp. 688-692
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. © 2020 European Foot and Ankle Society
Shahabi, S.,
Maharlouei, N.,
Jalali, M.,
Lankarani, K.B. Shiraz E-Medical Journal (17351391)22(6)
Jalali, M.,
Shahabi, S.,
Lankarani, K.B.,
Kamali, M.,
Mojgani, P. Disability and Society (13600508)35(5)pp. 844-847
This is a Current Issue because, at the time of writing, COVID-19 has affected many countries and territories worldwide and Iran ranked early on as one of the most seriously affected countries. As a result, this pandemic crisis poses a considerable challenge to people with disabilities in Iran. In this short article we show the different challenges people with disabilities are facing during the COVID emergency in Iran. In addition, we provide several recommendations, based on our perspective and experience in Rehabilitation and Health Policy Centres, to improve the situation in the content of the COVID-19 breakout. © 2020, © 2020 Informa UK Limited, trading as Taylor & Francis Group.
Current Orthopaedic Practice (19417551)31(4)pp. 352-357
Reinjury has occurred at a high rate after anterior cruciate ligament (ACL) reconstruction. Low knee flexion angles and high peak posterior ground reaction forces in landing tasks increase ACL loading. Some studies reported that rocker-sole shoes increased knee flexion angle in the early stance phase of the gait. The aim of this study was to investigate the biomechanics of walking with a custom-made heel-to-toe rocker shoe design, with special attention to the sagittal knee joint kinematics of patients after ACL reconstruction.Methods:This study examined 10 male participants with ACL-reconstruction participants. Three-dimensional gait analysis was performed under two conditions of level walking that were tested in random order using either modified footwear adapted with a heel-to-toe rocker sole or baseline footwear with a flat sole. The knee flexion angle at initial foot contact with the ground, average knee flexion angle from heel strike to 25% stance phase, and first peak knee flexion angle were compared across footwear conditions.Results:Walking with the heel-to-toe rocker shoes increased the knee flexion angle at the early stance phase of the gait cycle when compared with the baseline footwear.Conclusions:Rocker-shoe intervention was found to have potential as a rehabilitation tool to modify gait patterns in the sagittal plane of people with ACL-reconstructed knees and may protect against high reinjury rates. Further research is required to evaluate whether prolonged wear of rocker-sole shoes can modify lower extremity biomechanics of participants who have undergone ACL reconstruction.Level of Evidence:Level II. © 2020 Lippincott Williams and Wilkins. All rights reserved.
Jalali, A.,
Azadinia, F.,
Jalali, M.,
Saeedi, H.,
Shahabi, S.,
Rajabi moghadam, A. Footwear Science (19424280)pp. 161-171
Appropriate shoe fit is an important factor for preventing foot disorders in older adults. This cross-sectional, observational study evaluated the shoe and foot mismatch of the older people and their footwear characteristics in Tehran city. Eighty senior citizens (50 women and 30 men) participated in this study. Their age range was from 65 to 87 years old. Fifty-seven of them (71.3%) were wearing shoes with improper lengths and 23.7% of them wore shoes with shorter lengths. All of the shoes and feet measurements differences were significant (length difference = −0.4 ± 0.7 (p = 0.000), metatarsophalangeal (MP) width difference = 1.2 ± 0.8 (p = 0.000), MP perimeter difference = 1.6 ± 0.8 (p = 0.000), heel width = 0.3 ± 0.7 (p = 0.000)). In more than 90% of the participants, the shoe’s width and MP region perimeter were shorter than the feet. We found weak but significant relationships between narrower MP and heel widths and hallux valgus (r = 0.33, p = 0.003 and r = 0.29, p = 0.009, respectively). Our results show that most of the participants wear poor-fitting shoes. It seems that many older adults have poor footwear with characteristics like non-supportive heel counter and no fixation. © 2020, © 2020 Informa UK Limited, trading as Taylor & Francis Group.
Farzadi, M.,
Sanjari, M.A.,
Jalali, M.,
Saeedi, H.,
Kamali, M.,
Movahedi yeganeh, M. Foot (09582592)45
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. © 2020 Elsevier Ltd
Conflict and Health (17521505)14(1)
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 Author(s) 2020.
Pourhoseingholi, E.,
Kamali, M.,
Saeedi, H.,
Jalali, M. Medical Journal Of The Islamic Republic Of Iran (22516840)34pp. 1-7
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. This work has been published under CC BY-NC-SA 1.0 license. Copyright © 2020. Iran University of Medical Sciences.
Pourhoseingholi, E.,
Saeedi, H.,
Kamali, M.,
Jalali, M. Medical Journal Of The Islamic Republic Of Iran (22516840)34(1)pp. 1-5
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. This work has been published under CC BY-NC-SA 1.0 license. Copyright © 2020. Iran University of Medical Sciences.
Shahabi, S.,
Shabaninejad, H.,
Kamali, M.,
Jalali, M.,
Teymourlouy, A.A. Clinical Rehabilitation (14770873)34(2)pp. 145-159
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. © The Author(s) 2019.
Shahabi, S.,
Lankarani, K.B.,
Heydari, S.T.,
Jalali, M.,
Ghahramani, S.,
Kamyab, M.,
Tabrizi, R.,
Hosseinabadi, M. Prosthetics and Orthotics International (17461553)44(5)pp. 341-354
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. © The International Society for Prosthetics and Orthotics 2020.
Moulodi, N.,
Azadinia, F.,
Ebrahimi-takamjani, I.,
Atlasi, R.,
Jalali, M.,
Kamali, M. Foot (09582592)45
Background: The intrinsic foot muscles are vital for maintaining normal foot function. This study was conducted to systematically review the literature on the functional capacity and morphological characteristics of the intrinsic foot muscles in subjects with Hallux Valgus (HV) deformity. Methods: A search was carried out in all available electronic databases, including Pub Med, Scopus, Embase and Web of Science, for identifying any relevant studies published from 1990 to October 2018. Results: Three studies had investigated intrinsic foot muscle size using ultrasound imaging; two had reported electromyography parameters and four had measured the muscle force capacity. The results of the present review suggested that the functional capacity and morphological characteristics of intrinsic foot muscles are different in subjects with HV compared to those without this deformity. Conclusion: This review found scientific evidence on muscle performance impairment in the abductor hallucis and flexor hallucis brevis in subjects with HV deformity. © 2020 Elsevier Ltd
Rezaeian, T.,
Jalali, M.,
Mojgani, P.,
Messenger, N.,
Strauss, D. Journal of Military Medicine (17357667)21(3)pp. 262-271
Background and Aim: Lower limb amputation and prosthesis use affect mobility and other aspects of amputees’ daily activities. Awareness of these effects may aid health-care and rehabilitation systems in improving quality of life and well-being of lower limb amputees. A questionnaire was used to collect data about the conditions resulting from lower limb amputation, mobility, low back pain, balance confidence in different activities, and quality of life. Methods: A survey composed of three standard questionnaires including part of Prosthesis Evaluation Questionnaire (PEQ), complete Activities-Specific Balance Confidence (ABC) Scale questionnaire, and complete Oswestry Disability Index (ODI) was designed and published online. The study’s statistical population included lower limb amputees with any level of amputation who were aged >18 years. The questionnaire was publicised through the prosthetic clinic in the Comprehensive Rehabilitation center of Iranian Red Crescent in Tehran by colleagues working in the fields of amputee rehabilitation, social channels related to disabilities, and the social media of the “Iranian Handicapped Society”. The questionnaire was available online in Persian. Data collection was performed over 16 months (August 2016‒December 2017). Results: Of the 37 respondents (including 1 female and 1 bilateral amputee), many suffered from phantom limb sensation (21 participants/56.8%), phantom limb pain (18 participants/48.6%), stump pain (19 participants/51.4%), intact-side pain (22 participants/59.5%), falls during the last 12 months (22 participants/59.5%) and worry about falling (28 participants/75.7%), deficient balance confidence as measured by the ABC scale (26 participants/70%), and risk of future fallings (17 participants/46%). These problems negatively affected respondents’ ODI scores, ABC scores, mobility scores and quality of life (QoL) scores. However, despite the high rate of lower back pain (LBP) among respondents (22 participants/59.5%), intensity of pain was mild and moderate for the majority. LBP was associated with lower scores of ABC scale, mobility, QoL and amputees satisfaction with prosthesis. According to the ODI, 24% and 32% of participants respectively had minimal and moderate disability due to LBP. Conclusion: Problems related to balance, pain in amputated and intact sides, and LBP were common among respondents. These issues likely impact their mobility and QoL. Accordingly, it is necessary for health care/ rehabilitation systems to include screening plans to monitor these problems and manage them appropriately. © 2019 Baqiyatallah University of Medical Sciences. All rights reserved.
Spine Deformity (22121358)7(4)pp. 553-558
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. © 2018 Scoliosis Research Society
Khoshhal, Y.,
Jalali, M.,
Babaee, T.,
Ghandhari, H.,
Gum, J.L. Asian Spine Journal (19767846)13(6)pp. 1028-1035
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 hemi-pelvic 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. © 2019 by Korean Society of Spine Surgery.
Barati, K.,
Saeedi, H.,
Hajiaghaei, B.,
Jalali, M.,
Curran, S. Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine (09544119)233(4)pp. 407-413
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. © IMechE 2019.
Jalali, M.,
Farahmand, F.,
Esfandiarpour, F.,
Golestanha, S.A.,
Akbar, M.,
Eskandari, A.,
Mousavi, S.E. Gait and Posture (18792219)63pp. 52-57
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. © 2018 Elsevier B.V.
Khodaei, B.,
Saeedi, H.,
Jalali, M.,
Farzadi, M.,
Norouzi, E. Foot (09582592)33pp. 76-80
Backgrounds The effect of foot orthoses on plantar pressure distribution has been proven by researchers but there are some controversies about advantages of custom-made foot orthoses to less expensive prefabricated foot orthoses. Methods Nineteen flatfeet adults between 18 and 45 participated in this study. CAD–CAM foot orthoses were made for these patients according to their foot scan. Prefabricated foot orthoses were prepared according to their foot size. Plantar pressure, force and contact area were measured using pedar®-x in-shoe system wearing shoe alone, wearing CAD–CAM foot orthoses and wearing prefabricated foot orthoses. Repeated measures ANOVA model with post-hoc, Bonferroni comparison were used to test differences. Results CAD–CAM and prefabricated foot orthoses both decreased pressure and force under 2nd, 3–5 metatarsal and heel regions comparing to shoe alone condition. CAD–CAM foot orthosis increased pressure under lateral toe region in comparison to shoe alone and prefabricated foot orthosis. Both foot orthoses increased pressure and contact area in medial midfoot region comparing to shoe alone condition. Increased forces were seen at hallux and lateral toes by prefabricated foot orthoses in comparison with CAD–CAM foot orthoses and control condition, respectively. Conclusion According to the results, both foot orthoses could decrease the pressure under heel and metatarsal area. It seems that the special design of CAD–CAM foot orthoses could not make great differences in plantar pressure distribution in this sample. Further research is required to determine whether these results are associated with different scan systems or design software. © 2017 Elsevier Ltd
Farzadi, M.,
Nemati, Z.,
Jalali, M.,
Doulagh, R.S.,
Kamali, M. Foot (09582592)31pp. 72-76
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. © 2017 Elsevier Ltd
Hajiaghaei, B.,
Ebrahimi-takamjani, I.,
Kamyab, M.,
Saeedi, H.,
Jalali, M. Medical Journal Of The Islamic Republic Of Iran (22516840)30(1)
Background: Creating a socket with proper fit is an important factor to ensure the comfort and control of prosthetic devices. Several techniques are commonly used to cast transtibial stumps but their effect on stump shape deformation is not well understood. This study compares the dimensions, circumferences and volumes of the positive casts and also the socket comfort between two casting methods. Our hypothesis was that the casts prepared by air pressure method have less volume and are more comfortable than those prepared by weight bearing method. Methods: Fifteen transtibial unilateral amputees participated in the study. Two weight bearing and air pressure casting methods were utilized for their residual limbs. The diameters and circumferences of various areas of the residual limbs and positive casts were compared. The volumes of two types of casts were measured by a volumeter and compared. Visual Analogue Scale (VAS) was used to measure the sockets fit comfort. Results: Circumferences at 10 and 15 cm below the patella on the casts were significantly smaller in air pressure casting method compared to the weight bearing method (p=0.00 and 0.01 respectively). The volume of the cast in air pressure method was lower than that of the weight bearing method (p=0.006). The amputees found the fit of the sockets prepared by air pressure method more comfortable than the weight bearing sockets (p=0.015). Conclusion: The air pressure casting reduced the circumferences of the distal portion of residual limbs which has more soft tissue and because of its snug fit it provided more comfort for amputees, according to the VAS measurements.
Jalali, M.,
Farahmand, F.,
Rezaeian, T.,
Ramsey, D.K.,
Mousavi, S.M.E. Prosthetics and Orthotics International (17461553)40(2)pp. 270-276
Background: The use of functional knee braces for returning to sports or during demanding activities following anterior cruciate ligament rupture is common; yet despite being commonly prescribed, its mechanism of action remains unknown. Objectives: To examine the effect of functional knee braces on mean muscle activity when performing lunge exercises. Study design: Pre-/post-test (within-subject research design). Methods: A total of 10 male participants with unilateral isolated anterior cruciate ligament deficiency participated. Electromyographic activities of six muscles around the knee were recorded during lunge exercises, with and without wearing a custom functional knee brace. The lunge cycle movement was subdivided into three phases: eccentric, isometric, and concentric. Results: The quadriceps and hamstrings were no different in the braced and unbraced conditions. When braced, the mean amplitude of the medial gastrocnemius was significantly lower throughout the whole movement (p = 0.01) and during the concentric (p = 0.006) and eccentric (p = 0.028) phases, but not within the isometric phase. The lateral gastrocnemius was found to have lower mean amplitude in the isometric phase (p = 0.044). Conclusion: With its origin on the medial femoral condyle, perhaps reduced medial gastrocnemius activity may better guide knee rotation and assist the joint achieving a healthier kinematic pattern. Clinical relevance Lower medial gastrocnemius activity may facilitate lower medial compartment contact pressure, for which greater loading is known to increase the risk of osteoarthritis in anterior cruciate ligament-deficient (ACLD) knees. However, further research is needed.
Jalali, M.,
Farahmand, F.,
Mousavi, S.M.E.,
Golestanha, S.A.,
Rezaeian, T.,
Broujeni, S.S.,
Rahgozar, M.,
Esfandiarpour, F. Iranian Journal Of Radiology (20082711)12(3)
Background: Despite several studies with different methods, the effect of functional knee braces on knee joint kinematics is not clear. Direct visualization of joint components through medical imaging modalities may provide the clinicians with more useful information. Objectives: In this study, for the first time in the literature, video fluoroscopy was used to investigate the effect of knee bracing on the sagittal plane kinematics of anterior cruciate ligament (ACL) injured patients. Patients and Methods: For twelve male unilateral ACL deficient subjects, the anterior tibial translation was measured during lunge exercise in non-braced and braced conditions. Fluoroscopic images were acquired from the subjects using a digital fluoroscopy system with a rate of 10 fps. The image of each frame was scaled using a calibration coin and analyzed in AutoCAD environment. The angle between the two lines, tangent to the posterior cortexes of the femoral and tibial shafts was measured as the flexion angle. For the fluoroscopic images associated with 0°, 15°, 30°, 45° and 60° knee flexion angles, the relative anterior-posterior configuration of the tibiofemoral joint was assessed by measuring the position of landmarks on the tibia and femur. Results: Results indicated that the overall anterior translations of the tibia during the eccentric (down) and concentric (up) phases of lunge exercise were 10.4 ± 1.7 mm and 9.0 ± 2.2 mm for non-braced, and 10.1 ± 3.4 mm and 7.4 ± 2.5 mm, for braced conditions, respectively. The difference of the tibial anterior-posterior translation behaviors of the braced and non-braced knees was not statistically significant. Conclusion: Fluoroscopic imaging provides an effective tool to measure the dynamic behavior of the knee joint in the sagittal plane and within the limitations of this study, the pure mechanical stabilizing effect of functional knee bracing is not sufficient to control the anterior tibial translation of the ACL deficient patients during lunge exercise. © 2015, Tehran University of Medical Sciences and Iranian Society of Radiology.
