akram azad

Parkinson's disease (PD) is a neurodegenerative disorder characterized by motor and non-motor symptoms that can impact daily activities.

Activity-based interventions, particularly when combined with motivational strategies, may enhance upper extremity function and participation in people with PD.

This study will include forty-five patients with PD aged 35 to 85 years, categorized as stages I to III according to the Hoehn and Yahr Scale. Patients will be recruited from neurological and rehabilitation centers and randomly assigned to one of three intervention groups: Activity-based interventions with motivational strategy, activity-based interventions without motivational strategy, and conventional interventions. All participants will undergo a 24-session intervention, three times a week. The study will assess various outcomes at multiple time points, including baseline, session 10, session 18, post-intervention (week 9), and follow-up (week 17). Primary outcome measures will focus on motor control of the upper extremity and participation, while secondary outcome measures will include cognitive function and quality of life.

This proposed randomized controlled trial (RCT) aims to investigate the potential beneficial effects of activity-based interventions, combined with motivational strategies, on upper extremity function and participation in activities of daily living (ADLs) for individuals with PD.

The expected outcome of this study is to provide valuable insights that can assist occupational therapists in making informed decisions regarding intervention plans for people with PD.

This study investigated the efficacy of telerehabilitation (TR) in school-based Occupational Therapy (OT) for children with Specific Learning Disorder (SLD), focusing on occupational competence and parental satisfaction, aiming to contribute empirical insights to the discourse on the educational well-being of this population.

The study adopted a Randomized Controlled Trial (RCT) design involving 31 children diagnosed with SLD, implementing TR and in-person interventions alongside a control group. Outcome measures included the School Self-Concept Inventory, Child Occupational Self-Assessment (COSA), and Canadian Occupational Performance Measurement (COMP), analyzed using descriptive and inferential statistics (ANOVA, post hoc tests).

Both TR and in-person interventions exhibited significant enhancements in academic self-efficacy (F=23.96, p<0.001, Partial ȵ²=0.461), occupational competence (F=70.59, p<0.001, Partial ȵ²=0.716), and parent satisfaction (F=17.03, p<0.001, Partial ȵ²=0.378) compared to the control group. Notably, no significant differences emerged between the TR and in-person groups, emphasizing their comparable effectiveness in improving outcomes.

In conclusion, the study demonstrated the efficacy of TR and in-person interventions in school-based OT for children with SLD. The cohesive outcomes in academic self-efficacy, occupational competence, and parental satisfaction highlight TR as a versatile modality. This research, grounded in robust methodology, encourages further exploration of TR’s transformative role in enhancing the holistic well-being of children with SLDs.

 Handwriting is one of the most common reasons for referral to occupational therapy among children with specific learning disorders (SLDs). The Persian handwriting assessment tool (PHAT) is a valid assessment instrument. It is important to clarify the reliability of this assessment tool for the accuracy of results and certain clinical uses in Iranian children with SLDs.

 The present study aimed to investigate the internal consistency, test-retest, and inter-rater reliability of the PHAT in children with SLDs aged 10 to 12 years in the Iranian context.

 Thirty children (mean ± SD 132.33 ± 53.8 months) with SLDs, studying in grades 4 to 6, were recruited from special education schools and rehabilitation clinics from January to May 2022. Cronbach's alpha and intraclass correlation coefficient (ICC) were calculated to determine internal consistency, test-retest reliability, and inter-rater reliability, respectively. The standard error of measurement (SEM) and minimal detectable change (MDC) were computed to establish absolute reliability.

 Internal consistency was excellent (α = 0.98 to 0.99), as was inter-rater reliability (ICC = 0.95 to 1.00). Test-retest reliability was good to excellent (0.86 to 1.00). The SEM and MDC values for test-retest reliability were 0 to 0.47 and 0 to 1.29, respectively. Finally, the SEM (0 - 0.21) and MDC (0 - 0.57) values were acceptable for inter-rater reliability.

 The PHAT is a reliable assessment tool for Iranian children with SLDs aged 10 to 12 years. Further, clinicians can utilize this tool to identify handwriting difficulties in children with SLDs aged 10 to 12 years, which leads to more targeted interventions.

Multiple sclerosis (MS) is one of the most common causes of disability in neurological diseases, especially in the age of 20-40 years. Many factors caused by the disease have a significant impact on the quality of life the MS patients. The purpose of this study was to investigate the demographic factors including age, gender, occupation, marital status, education level, duration of disease, and the type of disease. Also, it was to survey the factors caused by the disease. such as the severity of depression, disability, cognition, and pain which all can affected the quality of life.

This non-experimental and cross-sectional study was conducted on 82 cases with multiple sclerosis (53 people with relapse-recovery type and 29 people with secondary progressive type) in a simple, non-randomized manner in the age group of 25-60 years. In order to investigate the relationship between variables and the factors affecting the quality of life, Pearson and Spearman correlation tests and multiple regression tests were used, considering the alpha level to be equal to 0.05.

The results of multiple regression demonstrated that all the above factors had a high correlation with the physical and psychological conditions of the MS patients' quality of life, with a correlation coefficient of 0.89 and 0.85, respectively. Moreover, depression severity and disability level were the most important influencing factors in determining the physical condition of the MS patients' quality of life, with the standard beta coefficient of -0.48 and -0.35, respectively. The only effective factor in the psychological state of the MS patients' quality of life was the depression severity (with a standard beta coefficient of -0.67).

The severity of depression is a critical and effective factor in the quality of life of people with multiple sclerosis

Fatigue is common after chronic stroke, which may cause upper extremity sensory-motor dysfunction, as well as decreased independence in activities of daily living (ADLs) and participation. This study aimed to investigate the effects of upper extremity exercises based on fatigue prediction on sensory-motor functions and ADLs in subjects with chronic stroke.

This is a pilot study. Twenty subjects with chronic stroke (11 male and 9 female) with mean age of 56±14.09 years and mean time since the stroke of 71.05±53.5 months were randomly assigned to either the control group (receiving conventional rehabilitation) or intervention group (receiving unimanual exercises based on fatigue prediction) using the Kinect Upper extremity motor function. Fine and gross manual dexterity, grip strength, shoulder and elbow proprioception, independence in ADLs, participation, and fatigue severity were assessed before the interventions, after the interventions (6 week, each weak 3 session, for 45 minute) and 6 weeks following the completion of the interventions (i.e. follow up). 

In both control and intervention groups, a significant improvement was observed in all assessments (P≤0.05), except for independence in ADLs. Moreover, the decrease in fatigue severity and improvement in fine manual dexterity was significantly greater in the intervention group compared with the control group (P≤0.05). 

The results of this study indicated that upper extremity exercises based on fatigue prediction led to an improvement in upper extremity sensory-motor functions, manual dexterity, and participation as well as a decrease in fatigue severity in subjects with chronic stroke.

Changes caused by technological advancements in the health information management (HIM) departments of hospitals have increased the importance of this unit and created new educational needs for their staffs in this department. The current study aims to assess the educational needs of the HIM department staff of teaching hospitals in Ferdows, Iran.

This is a descriptive study conducted in 2021 in two teaching hospitals in Ferdows City. The study population consists of the staffs of the HIM department. Samples were selected using a census method. The data collection tool was Zarei et al.’s educational need assessment questionnaire in Persian. The collected data were reported using descriptive statistics in SPSS software, version 19.

Thirty HIM department staffs participated in this study. The need level for training in the fields of computer & information technology, data collection, health information classification, health statistical methods, and occupational safety and health were 65%, 70%, 70%, 65% and 60%, respectively. Results showed the high need for training (Mean: 2.1 to 3) in these five fields.

The educational needs of the HIM department staff in Ferdows City are high. The best way for improving their skills is holding training courses. Therefore, it is recommended that training courses be held according to their skill levels.

Passion generally refers to the stimuli that shape a certain pattern of behavior. It can affects all aspects of a person’s life, including education and academic success. The present study aims to assess the predictability of school engagement based on communication skills, self-restraint, perceived parenting style, and sensory processing.

This is a descriptive-analytical study using the structural equation modeling (SEM).The study population consists of all secondary school students in Tehran (district 6). Sampling was done using purposive and convenience sampling methods. Using Cochran’s formula, the minimum sample size was obtained 385. Data collection tools were Baumrind’s parenting styles questionnaire, communication skills test-revised (CSTR), self-restraint scale, adolescent/adult sensory profile, and School Engagement Measure. To evaluate the SEM model, the significance level and path coefficients were investigated using the bootstrap method (re-sampling and sequential) and student’s t-test. 

Of 385 participants, 199 were girls (51.7%) and 186 were boys (48.3%), mostly aged 16 years (47.8%). Their mean age was 17.1±0.84 years. Results showed that the coefficient of determination (R2), Stone-Geisser’s Q2, and path coefficients were positive in all variables. The R2 value was 0.71, indicating that the independent variables together could predict 71% of school engagement.

Communication skills, self-restraint, perceived parenting style, and sensory processing are predictors of school engagement in students. Among these variables, communication skills have the highest effect.

The patient evaluation measure (PEM) evaluates the hand health profile. Having an appropriate measurement tool for the assessment of hand outcomes in Iranian individuals with wrist disorders is essential for clinical and research settings. The objective of the present study was to examine the psychometric features of the PEM in Iranian individuals with wrist disorders.

Ninety individuals with wrist disorders were recruited. Hand outcome was evaluated with the PEM, quick-disabilities of the arm, shoulder, and hand (Q-DASH), visual analogue scale-pain (VAS-P), and JAMAR hand-grip dynamometer. The PEM was translated into Persian. Face, content, and convergent validity was examined. Also, acceptability, internal consistency, test-retest reliability, and absolute reliability were calculated.

All questions had an item impact score and CVR score of >1.5 and >0.42, respectively. All questions except for question 1 (CVI=0.76) and 10 (CVI=0.73) of section B had a CVI score of <0.79. After changes were applied, the CVI score for these questions (question 1=0.83; question 10=0.87) reached acceptable criteria. The total score of the PEM showed a significant moderate correlation with Q-DASH (ρ=0.51; P<0.001) and VAS-P (ρ=0.55; P<0.001) and an insignificant weak correlation with grip strength (ρ=-0.11; P>0.05). Floor and ceiling effects were 0% for the total PEM score. The Cronbach’s α and intra-class correlation values were 0.72-0.87 and 0.96-0.98, respectively. 

The present study suggests that the PEM has acceptable validity and reliability for measuring performance and satisfaction in individuals with wrist disorders. This measure might contribute as an outcome measure in research and routine assessments in clinical practice.

Balance screening has been identified as a major predictor of falls in the elderly. The current study compares the diagnostic accuracy of various balance instruments in community-dwelling older adults.

In this cross-sectional study, 145 older adults were recruited. The Berg balance scale (BBS), Fullerton advanced balance (FAB) scale, dynamic gait index (DGI), performance-oriented mobility assessment (POMA), timed up and go (TUG) test, gait speed, step length, step test, and single item question were administered. The receiver operating characteristics curve analysis was used to calculate diagnostic accuracy.

All single-item tools had moderate diagnostic accuracy (area under the curve [AUC]=0.76-0.89) and all multi-item tools had high diagnostic accuracy (AUC=0.91-0.95) when using the recommended cut-off point of 45 for BBS. All multi-item tools maintained high to moderate diagnostic accuracy (AUC=0.85-1.00) in all thresholds while using BBS severity cut-off points. The FAB scale showed the highest diagnostic accuracy (AUC=0.95) among all assessment tools. Single-item question scores (Wald=22.61, df=1, P=0.0001, Exp(B)=8.82) were significant as covariates in the regression model.

For older adults with or without a history of falling, the FAB scale demonstrated the highest diagnostic accuracy. Along with single-item tools, the FAB scale may be a preferred multi-item tool.

An ankle sprain is one of the most common musculoskeletal injuries and has various complications. Various factors can predict post-injury complications, including ankle muscle strength, pain, and activity level. So far, no study has exclusively investigated the predictive role of these factors. Therefore, this study aims to investigate the role of these factors in ankle instability, functional mobility, and gait speed in individuals with ankle sprain.

This study was conducted on 140 individuals with ankle sprains who were referred to medical centers in Shiraz City, Iran. The demographic information of the patients (including the time elapsed since the sprain, etc.) was recorded by a demographic questionnaire. Related tests were also used to evaluate ankle muscle strength, pain, activity level, ankle functional instability, functional mobility, and gait speed, respectively. 

In the regression models, the predictive value for each outcome of ankle functional instability, functional mobility, and walking speed was 45.5%, 58.8%, and 65.3% of the variance, respectively. In all stepwise models, ankle muscle strength was the strongest predictor for the outcomes of functional ankle instability, functional mobility, and gait speed.

Ankle muscle strength, level of education, history of sprain in the last year, and age were the vital predictors of ankle functional instability. Muscle strength, age, and sprain status were the critical predictors of functional mobility respectively. Muscle strength, pain, age, duration of sprain, and activity level were the crucial predictors of gait speed.

The Persian Handwriting Assessment Tool (PHAT) evaluates speed and legibility in copying and dictation domains. The aim of the present study was to determine psychometric validation and diagnostic accuracy features of the PHAT for students with specific learning disorder.

In this cross-sectional study, handwriting of 120 participants (typically developing students, N= 60; students with specific learning disorder, N= 60; mean age (SD): 9.23 ± 0.53 years and 9.13±0.56 years, respectively) were assessed with PHAT. Receiver Operating Characteristics (ROC) curve analysis was carried out to derive validity parameters and Area Under the Curve (AUC) for diagnostic accuracy. Discriminative validity, internal consistency, test-retest reliability and absolute reliability were examined.

The PHAT had significant ability to discriminate typically developing students from students with specific learning disorder in formation, spacing and alignment (AUC= 0.78-0.95) and moderate accuracy (AUC= 0.61-0.66) in text slant in both domains. Acceptable discriminative validity (P< 0.01), internal consistency (copying: α= 0.80-0.98; dictation: α= 0.83-0.98), and test-retest reliability (copying: ICC2,1= 0.75-0.98; dictation: ICC2,1= 0.78-0.98) were also obtained.

The current study suggests that the PHAT has satisfactory reliability, validity and high to acceptable diagnostic accuracy for students with specific learning disorder.

Pain in patients with stroke is one of the essential factors that caninfluence upper-limb performance, and it is better to divide these people intoseparate groups. The Adult-Assisting Hand Assessment (Ad-AHA) is a tool thatrecently is being used in upper-limb performance evaluation among patientswith stroke. The present study aimed to evaluate the diagnostic accuracy of theAd-AHA among patients with chronic stroke who had pain to discriminatebetween the high upper-limb performance group and the low upper-limbperformance group. In this cross-sectional study, 51 patients (mean age±SD = 69.33±8.73)with chronic stroke who had pain participated and were divided into two groupsof high (group 1) and low (group 2) upper-limb performance measured bythe Action Reach Arm Test. The best cutoff point between groups, sensitivity,and specificity by receiver operating characteristic (ROC) for Ad-AHA wascalculated. A significant difference in the total score of Ad-AHA between thehigh and low upper-limb performance groups was seen (P˂0.001). The bestcutoff point for the total score of Ad-AHA between stroke patients with highand low performance in the upper-limb who had pain was 47 (sensitivity=95.45,specificity=89.21). The results of this study show that the Ad-AHA has high sensitivityand specificity to discriminate between stroke patients with high and lowperformance in upper-limb performance who had pain.

 Fear of falling, balance, and environmental hazards are viewed as significant psychological and physical components in seniors. This systematic review was carried out to review psychometric properties of psychological and physical fall outcome measures in Persian older adults.

 The databases were searched using the COSMIN guideline recommendation search strategy and filters. A systematic search was undertaken utilizing the PubMed, Scopus, Medline, CINAHL, PsychINFO, ProQuest, Cochrane library, Web of Science, Pedro, SID, CIVILICA, Magiran, MEDLIB, IranDoc, and IranMedex, from 1971 to June 2021. A further hand search for grey literature was carried out through Google Scholar to detect papers that were not captured in electronic records.

 Of the initial 1268 studies, 33 studies met the inclusion criteria. Eight psychological and 12 physical assessment tools were validated for Persian older adults. The constructs studied were structural validity, internal consistency, and hypothesis testing that were based on reliable methodology with superb quality. In contrast, content validity was either doubtful or not reported. Neither of the studies that were included examined cross-cultural adaptation and responsiveness. The overall quality of the psychometric properties of each measurement tool has a broad range of inconsistencies (from high to low).

 As psychometric data proved inconsistency and conflict for the majority of studies, only provisional judgments may be established. Psychometric features for assessment instruments are clearly partial or lacking, limiting rationale for use in clinical settings or research until more psychometric information is provided.

This study aimed to investigate the effect of upper extremity coordination exercises based on fatigue prediction on fine and gross manual dexterity, upper limb motor function, shoulder and elbow proprioception, occupational performance, and activities of daily living in chronic stroke survivors.

In this pilot double-blind randomized clinical trial, 24 chronic strokes were enrolled using the non-probability sampling method. Participants were randomly allocated to the control (received routine occupational therapy) and intervention (received upper extremity coordination exercises based on fatigue prediction using the Kinect) groups. Before and after the interventions (six weeks, three sessions/week, 45 min/session), as well as six weeks after completion of interventions, participants were assessed using the following tools: Box-Block Test, Purdue-Pegboard Test, Wolf-Motor Function Test, Action Research Arm Test, Manual Ability Measure-16, Grip Dynamometer, Shoulder Position Sense Test (SPST), Elbow Position Sense Test (EPST), Canadian Occupational Performance Measure, Shah-Barthel Index (SH-BI), and Multi-dimensional Fatigue Inventory. This project was carried out in the rehabilitation department of Shafa-Yahyaeian Hospital from May 2019 to June 2020.

The results showed a significant improvement in all assessments of both control and intervention groups (P≤0.05), except for SH-BI. Further, the improvement of EPST and SPST scores in the intervention group was significantly greater than the control group (P≤0.05). Also, a significant decrease in fatigue severity was observed in both control and intervention groups (P≤0.05). 

These results suggest that upper extremity coordination exercises based on fatigue prediction in combination with routine occupational therapy could lead to improvement of upper extremity sensory-motor functions and power grip and caused a decrease in fatigue severity in chronic stroke.

Activities of Daily Living (ADL), as an ultimate goal of rehabilitation, rely on cultural and environmental factors. This study aimed to develop a questionnaire based on the occupational therapy practice frame to accurately evaluate Iranian children’s occupational performance.

This scale was developed in two phases of planning and construction. The planning phase involved a literature review and a collection of the available evaluation tools in the area. The advice of two expert panels was used to develop a preliminary 87-item questionnaire. In the construction phase, 40 parents were surveyed to assess the popularity of the activities in Iran. After a face to content validation, the final version of the questionnaire was prepared with 93 items.

The final 93-item questionnaire was used to assess the ADL of 3-6-year-old children. The 93 items, selected according to criteria found in the literature and the panel of experts, were categorized into six ranges of occupational therapy practice framework (bathing/washing/personal hygiene, toileting, dressing, eating/feeding, functional mobility, and others).

The ADL in Iranian children is a practical and culturally relevant tool for measuring the occupational performance of Iranian children. It can be used in clinical and population-based research.

Action Observation Therapy (AOT) is a top-down approach that has been recently introduced in the rehabilitation of neurological disorders mainly after stroke. The main goal of this study was to investigate the effects and feasibility of a new technique in AOT procedure (called self-AOT) following periods of no treatment and routine AOT intervention on upper limb motor function, occupational performance and neurophysiological changes in a stroke patient.

A single-subject A-B-A-C design was used and a 58-year-old woman with a 3-year history of left hemiplegia poststroke participated in this study. In the baseline (A1, A2) phases, the patient received no treatment. In the first intervention (B phase), she received a 4-week AOT, and in the second intervention (C phase), a 4 week of Self-AOT was practiced. In all phases, upper limb motor recovery as a target outcome was evaluated on 4 occasions using the Fugl-Meyer assessment. Upper limb function, dexterity and spasticity were assessed using Action Research Arm Test, Box-Block Test and Modified Modified Ashworth Scale respectively. Occupational Performance/Satisfaction was assessed with Canadian Occupational Performance Measure and to assess neuroplasticity, Motor Evoked Potential was recorded by Transcranial Magnetic Stimulation. Visual analysis, slope, and percentage of non-overlapping data were used for assessing the changes between phases.

Percentage of non-overlapping data and slopes indicated that motor recovery had clinically relevant improvements after both interventions compared to baselines. Other outcomes also showed improvements except for spasticity of wrist/elbow flexors and Motor Evoked Potential of opponens indicis.

Self-AOT may be as effective as other procedures of AOT for improving upper limb motor function, occupational performance/satisfaction, and cortical excitability post-stroke.

The first and most basic area of occupational performance is the activities of daily living. These activities of life highly depend on the contextual and ecological (environmental) factors. Cultural values, parental expectations, social routines, and physical environment influence acquisition time of a child’s daily activities. At present, there is no comprehensive and adapted-culturally tool to evaluate the daily life activities of Iranian children aged 3 - 6 years.

This study aimed to investigate the factor structure, construct validity, and reliability of the Activities of Daily Living in Iranian Children (ADLIC) scale.

The participants were 470 Iranian parents of children among the ages from 3 to 6. Exploratory factor analysis, internal consistency, and test-retest reliability were conducted for data analysis. Convergent validity was measured by correlation to the Pediatric Evaluation of Disability Inventory (PEDI).

The results indicated that ADLIC has excellent reliability due to internal consistency (Cronbach’s alpha 0.96). Furthermore, the temporal stability of ADLIC was supported using the Intra-class correlations coefficient, which ranged between 0.95 and 0.98. Convergent validity between the ADLIC and two subscales of PEDI, including self-care (0.88) andmobility (0.80), was good. The ADLIC scale showed a clear factor structure with five main components and ten factors based on the findings.

ADLIC has excellent psychometric properties, including internal consistency and temporal stability, and can be used as a reliable and valid measure to assess the daily living activities of children aged 3 - 6 years.

It is essential to have a suitable instrument for the accurate assessments of pain and disability outcomes during interventions; such tools also help to guide hand surgery and rehabilitation programs in distal radius or scaphoid fracture. This study aimed to evaluate the psychometric features of the Patient-rated Wrist Evaluation (PRWE) questionnaire in Iranians with a history of scaphoid and distal radius fractures.

One hundred and fifty subjects with a history of scaphoid and distal radius fractures were recruited from hospital-based outpatient hand clinics and completed the PRWE, 2 and 7 days after the occurrence of fracture. Additionally, the Quick-Disabilities of Arm, Shoulder, and Hand (Quick-DASH), the percentage of Wrist Range of Motion (%ROM), Visual Analog Scale Pain/Disability (VAS-P, VAS-D), Short-form Health Survey (SF-36) questionnaires, and pinch and grip strength (%) were conducted in the study participants. Cronbach’s alpha (α) coefficient and Intraclass Correlation Coefficient (ICC) were used to evaluate the internal consistency and test-retest reliability of the scale, respectively. Pearson or Spearman correlation coefficient was calculated for assessing the test’s construct validity.

No floor or ceiling effect was found. A very high test-retest reliability was obtained for the PRWE’s total score and subscores (ICC≥0.92). Cronbach’s α coefficient was obtained as ≥0.78 for the PRWE and its subscales. The PRWE total score presented a weak to strong (0.24-0.74) correlation with the average values of %ROM, %power grip, %pinch strength, VAS-P, VAS-D, SF-36, and Quick-DASH. The standard error of the measurement of PRWE total score equaled 3.93; its smallest real difference was 10.86. 

The PRWE presented acceptable validity and excellent reliability for measuring disability and pain in individuals with the scaphoid and distal radius fractures in Iran.

One of the most important areas in the rehabilitation of stroke patients is participation in meaningful activities. Participation of individuals with stroke in meaningful activities can increase their satisfaction and quality of life. The present study aimed to investigate the relationship between psychological factors and participation in meaningful activities as well as determining factors predicting participation in meaningful activities in patients with stroke.

In this cross-sectional study, 100 people with chronic stroke participated which were selected from four rehabilitation centers using a convenience non-probability sampling method. Participants were assessed using Meaningful Activity Participation Assessment (MAPA), Satisfaction with Life Scale (SWLS), Center for Epidemiological Studies of Depression Scale (CED-S), 36-Item Short-Form Health Survey (SF-36), Visual Analogue Scale for Fatigue (VAS ‐ F), and Visual Analog Scale for Pain (VAS Pain).

The severity of depression had the highest relationship with the level of participation in meaningful activities. Also, the severity of depression, cognitive status, pain intensity, and severity of fatigue were identified as significant factors predicting the rate of participation in meaningful activities of patients with stroke.

Participating in meaningful activities in people with stroke is an important issue and a major obstacle in the lives of people with stroke. As a result, identifying problems and making appropriate interventions to remove obstacles, such as fatigue, pain, cognitive problems, and most importantly depression should be a priority for professionals.

Individuals with moderate to severe traumatic brain injury (TBI) often have prolonged cognitive impairments, resulting in long-term problems with their real-life activities. Given the urgent need for evidence-based recommendations for neuropsychological management of Iranian TBI patients, the current work aimed to adapt eligible international guidelines for cognitive assessment and rehabilitation of the TBI patients in Iran.

The project was led by an executive committee, under the supervision of the Iranian Ministry of Health and Medical Education (MOHME). Following a systematic literature search and selection process, four guidelines were included for adaptation. Clinical recommendations of the source guidelines were tabulated as possible clinical scenarios for 90 PICO clinical questions covering all relevant phases of care. After summing up the scenarios, our initial list of recommendations was drafted according to the Iranian patients’ conditions. The final decision-making, with the contribution of a national interdisciplinary panel of 37 experts from across the country, was conducted in two rounds using online and offline survey forms (Round 1), and face-to-face and telephone meetings (Round 2).

A total of 63 recommendations in six sections were included in the final list of recommendations, among which 24 were considered as key recommendations. In addition, some of the recommendations were identified as fundamental, meaning that proper implementation of the other recommendations is largely dependent on their implementation.

Iranian health policy makers and rehabilitation program managers are recommended to address some fundamental issues to provide the necessary infrastructure to set up an efficient cognitive rehabilitation service system.

An appropriate and accurate assessment tool is needed to predict the risk of falling in older adults. This study aimed at investigating the construct validity, factor analysis, internal consistency, test-retest and inter-rater reliability, and ceiling/floor effects of the Persian version of Performance-oriented Mobility Assessment (POMA) in community-dwelling elderly.

One hundred and forty-five older adults aged 65 years and older (mean age: 73.68 years) were recruited from daily care centers of Tehran by convenience sampling method. Timed Up and Go (TUG) test and Berg Balance Scale (BBS) were used to investigate the construct validity of the POMA. Test-retest (7-14 days with interval) and inter-rater reliability of the gait and balance subscales and the total score of the POMA were determined by Intraclass Correlation Coefficient (ICC2,1). 

A moderate to very high correlation (r=0.67-0.9, P≤0.05) was found between the total score of the POMA and BBS, Fullerton Advanced Balance Scale, step test (right and left), TUG, Dynamic Gait index, and walking speed, whereas the correlation between the total score of the POMA and step length was poor (r=0.39, P≤0.05). The results of confirmatory factor analysis showed a poor goodness-of-fit of POMA with the two-factor model (balance and gait) in community-dwelling elderly. Internal consistency (Cronbach's alpha=0.94), test-retest reliability (ICC2,1)=0.97), as well as inter-rater reliability (ICC2,1)=0.92) of the POMA were excellent. The results revealed no floor effect for the total score of the POMA; however, its ceiling effect was 3.44%. 

The Persian version of POMA showed excellent psychometric properties for evaluating different aspects of balance in community-dwelling elderly.

Flexion contracture in fingers of hands is a complication of Dupuytren’s contracture and cannot be stopped by the progressive course. The aim of this study was to review the effect of splinting in the correction of contracture after Dupuytren’s contracture operation.

To carry out this research, a kind of systematic evidence-based review process (Duffy 2005) was used. For data gathering, we used electronic database and Persian- and English-language specific journals between 1990 and January 2019. The keywords were related to examine the effect of various splinting after Dupuytren’s contracture operation.

After data gathering, 26 articles about Dupuytren’s contracture were found; after checking and deep reviewing of those articles, 17 articles were removed from the study and 9 articles were included in the study for reviewing. The results of a review article based on using splint in Dupuytren’s contracture after operation were classified into 6 categories, including static splint, dynamic splint, day splint, night splint, the time duration of splinting, and prescribed time of splinting.

Splint alone has been ineffective in reducing contracture. Static splint and hand therapy (exercise) are together the most effective way for the treatment of Dupuytren’s contracture. Occasional and irregular use of splint also has no effect on pain relief and the reduction of contracture. The pressure and force of splint will be gradually increased, and the splint should be used at least for 3 months, too.

Handwriting problems are one of the common problems among students in the early years of education. The current study aimed to determine further validation aspects of the Persian Handwriting Assessment Tool (PHAT) in primary school-aged children. The current methodological study was conducted on 452 healthy 8-10-year-old students in Tehran, Iran, selected via random cluster sampling method. Inclusion criteria were native Persian-speaking and no documented physical and mental impairments. Construct and structural validities were established by exploratory factor analysis (EFA) using principal axis factoring with Promax rotation and confirmatory factor analysis (CFA), respectively. Criterion validity was examined by expert opinion as the gold standard using Pearson correlation test. Internal consistency, test-retest, and inter-rater reliability were examined using Cronbach’s alpha and intra-class correlation (ICC). Test-retest had a seven-day interval. The EFA results indicated two separate factors in the copying and dictation domains. Speed and orthographic error and size were considered as separate items. The CFA confirmed the factor structure. Criterion validity revealed low to moderate correlation (formation: 0.548, P<0.001; 0.503, P<0.001, spacing: 0.553, P<0.001; 0.307, P=0.030, alignment: 0.442, P<0.001; 0.358, P=0.011, size: -0.376, P=0.007; -0.445, P<0.001, and slant: 0.360, P=0.010; 0.372, P=0.008) in copying and dictation domain, respectively. Acceptable internal consistency (Cronbach’s alpha: 0.72-0.99), excellent test-retest (ICC: 0.76-0.99), excellent inter-rater reliability between teachers (ICC: 0.86-0.95), and good to excellent inter-rater reliability between teachers and the occupational therapist (ICC: 0.60-0.95) were reported. The results indicated that the PHAT was a valid and reliable tool for assessing handwriting in primary school-aged children.

To investigate the correlation between reach and grasp kinematic measures and clinical measures of gross and fine manual dexterity in patients with idiopathic Parkinson Disease (PD). 

Sixty patients (44 men, 16 women) with idiopathic PD (Mean±SD of age: 59.85±11.89 years) were recruited in this non-experimental cross-sectional study using a non-probability sampling method. Their gross and fine manual dexterity were assessed using the Box and Block Test (BBT) and Nine Hole Peg Test (NHPT), respectively. Also, reach and grasp kinematic measures (including normalized movement time, peak velocity, Maximum Grip Aperture [MGA], and percentage of movement time in which MGA occurred [PMGA]) were measured in the more affected hand. 

The results showed a significant and moderate correlation between reach kinematic measures (i.e. normalized movement time and peak velocity) and both gross and fine manual dexterity assessed by BBT (P=0.000) and NHPT (P=0.000), respectively. However, there was not a significant correlation between grasp kinematic measures (i.e. MGA and PMGA) and gross manual dexterity measured by BBT (P>0.05) as well as fine manual dexterity assessed by NHPT (P>0.05). 

This study showed no to moderate correlation between reach and grasp kinematic measures and clinical measures of gross and fine manual dexterity in patients with PD, supporting the significance of multi-level evaluation using both clinical and kinematic measures in the evaluation of upper limb function in patients with PD.

Given the increasing population of older adults in different societies, it is important to take into account the needs of them. In this regard, the most important things that are closely related to their quality of life are their ability in evaluating Activity of Daily Living (ADL) and Instrumental Activity of Daily Living (IADL) performances. The aims of the present study were to identify the outcome measures specific to the ADL and IADL for older adults and to investigate the psychometric properties of these measures.

This is a systematic review done on the articles published between June 2019 and February 2019. Articles in English language from these database included: Medline, PubMed, Google Scholar, CINAHL, OVID Medline, Cochrane, ProQuest, Up to Date, Web of Science, OT search, OT direct, Pedro, SID, Magiran, Iran Medex, MEDLIB and Iran doc. English keywords included: “Activity of Daily Living (ADL)”, “Instrumental Activity of Daily Living (IADL)”, “assessment”, “evaluation”, “aging”, “ageing”, “older adults”, “elders”, “Basic Activity of Daily Living (BADL)”, “Advanced Activity of Daily Living (AADL)”, “basic functions”, “self-care”, “mobility”, “independency”, “dependency”, “occupational therapy”, “physical therapy”, “rehabilitation”. The Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist were employed to investigate the psychometric properties of the studies.

Of the initial 482 studies considered, 13 studies met the inclusion criteria that assess the ADL and IADL performance of older adults. In this regard, 8 outcome measures were found especially for ADL assessment and 5 for IADL assessment.

Most of the assessment tools are performance-based and have been developed in especial contexts and especial groups of older adults. Some have been used frequently in different contexts but some were used less than others. None of these measures has been developed in Iran. So, for better assessment and having better intervention plans for older adults in Iran, it is suggested to develop an instrument that is especially designed for Iranian context.