فصلنامه آرشیو توانبخشی
سال بیست و یکم شماره 3 (پیاپی 84، پاییز 1399)

 Aging is one of the critical and growing stages in Iran. Falling is one of the most common problems in this period that leads to mobility, social limitations and even death. To increase the awareness and prevent secondary hazards due to falls, this study was conducted as a review article aiming the prevalence of falls based on evidence and related factors in Iranian elderly.
Materials &

In this study, the Prism method includes research published from 2008 to 2018 focusing on the prevalence of falls based on evidence and related factors in the Iranian elderly and the keywords prevalence, falls, falls-related factors, the elderly In the scientific database of PubMed and Scopus, Google Scholar, SID, Magiran, Irandoc. After reviewing the studies, 394 articles were obtained and finally, by reviewing the abstracts, 14 articles were selected.

 The results of Iranian studies were reported very differently. There was a significant relationship between aging, marriage, education, neurological diseases, painkillers, and home safety.

 The findings of this review study show an increase in the frequency of falls in the Iranian elderly that it is worthwhile to consider one of the health policies in this period of life to prevent and reduce the causes of falls at this age to reduce costs. Reduce the health caused by fall related injuries. Since prevention and education programs are not implemented in the elderly, the results of this study can help identify the importance of treatment costs and the harmful status.

 Because of the significant prevalence of diabetes, disability of patients due to the complication of Diabeti Neuropathy (DN) has been increased. Physiotherapy is one of the methods for DN which can help control the symptoms through modalities such as infrared radiation, electrical stimulation and electromagnetic fields. Tecar therapy is a form of electromagnetic fields.This study investigated the effect of Capacitive Tecar therapy on pain and tactile sensation of the feet in type 2 diabetics with symptoms of peripheral neuropathy. 

This clinical trial was performed as pre-test and post-test with a control group. The samples consisted of 24 diabetics aged 17-78 years with symtoms of peripheral neuropathy allocated in the control and experimental group randomly. The patients of experimental groups participated in 10 sessions and received the Capasitive tecar therapy with 10%-30% intensity in addition to infrared radiatin; the controls received the same protocol with zero intensity of tecar. Pain and tactile sensation of the soles were evaluated before and after sessions. The collected data were analyzed by the Reapeted measure Analysis Of Variance (ANOVA). All statistical analyses were performed in SPSS V. 18. The significance level was set at P<0.05.

 The results of Rearetd Measure ANOVA showed that there was a significant difference in the mean scores of pain and tactile sensation of soles in the post-test compared to the pre-test of two groups.(P<0.001).There was also a significant difference in the means of post-test scores of variable pain (P=0.002) and tactile sensation (P<0.001) between the two groups. The improvement of variables in experimental group was more than control group.

 The results of this study revealed that Tecar Therapy with infrared radiation can be an appropriate therapeutic program for improving pain and tactile sensation of soles in diabetic patients with symptoms of peripheral neuropathy.

 Congenital anomalies are functional or structural anomalies that can occur as a single or a group of anomalies. Studies have shown that socioeconomic factors can affect congenital anomalies such that the middle- and low-income countries suffer more from the congenital anomalies. This study aimed to determine the essential socioeconomic determinants of the disability-adjusted life year (DALY) for congenital anomalies in children aged <5 years.

This is a cross-sectional study using the latest available data in 2017, which were extracted from the international databases of the World Bank, the Institute for Health Metrics and Evaluation, and the United Nations Educational, Scientific, and Cultural Organization. In the study, we analyzed data from 196 countries divided into 6 geographical regions of African Region (AFRO), European Region (EURO), Pan American Health Organization (PAHO), Eastern Mediterranean Region (EMRO), Western Pacific Region (WPRO), and South-East Asia Region (SEARO). To identify the main determinants of the DALY, gross domestic products (GDP) per capita, poverty rate, government, private and external health expenditures per capita, mean years of schooling, and literacy rate were used. Data analysis was performed in STATA v.15 using the one-way ANOVA and the linear regression analysis.

 The lowest and highest rates of DALY was reported in Luxembourg (856.29 per 100000 population) and Sudan (21714.7 per 100000 population), respectively. The AFRO and EURO regions had the highest (9392.78±4250.56), and the lowest (2969.11±1961.64) mean of DALY. In Iran, the DALY rate was reported 7721.48 per 100000 population, which was higher than those in the EURO and PAHO regions and lower than those in the AFRO and EMRO regions. The results of linear regression analysis showed that mean years of schooling was the strongest predictor of DALY (β=-0.44, P=0.001) followed by the poverty rate (β=0.36, P=0.002). The results of one-way ANOVA indicated that the rate of DALY was significantly different between different social and economic groups, and it was higher in the lower socioeconomic groups. 

 Mean years of schooling and poverty rate are the strongest predictors of DALY for congenital anomalies in children under 5 years of age. Low-income countries, especially those in the AFRO and EMRO regions, are the most prone to the disability and premature death caused by congenital anomalies in children under 5 years of age compared to the high-income countries. Therefore, the equitable distribution of screening and health care services and educational infrastructures for deprived and lower socioeconomic countries should be taken into account by national and international health organizations.

 Demographic and epidemiological changes in the 21st century have created new challenges such as aging and the rising trend of non-communicable diseases. The high prevalence of disability (due to the growing aging population), non-communicable diseases, and accidents have increased the demand for rehabilitation services. However, there are not enough resources to meet all current needs in many parts of the world. The purpose of this study is to investigate the inequality in the utilization of rehabilitation services between Iranian households in urban and rural areas.

This is a descriptive-analytical study with a cross-sectional design using the household expenditure, income survey data from the Statistics Center of Iran in 2018. The used instrument was a questionnaire surveying the expenditure and income of urban and rural households (social characteristics of household members, place of residence and main living facilities, food/non-food expenses, and household income), which was completed through interviewing the household head or a member over 15 years of age. The study samples were 18610 households in rural areas and 20348 households in urban areas. After extracting and refining the data, 38958 households were included in the study. Factors affecting their utilization of rehabilitation services and the inequality in utilization were analyzed using the Chi-square test and the concentration index (CI), respectively. Data were extracted in MS Access 2013 and MS Excel 2013 applications and were analyzed in STATA V.14.1 software. The geographic distribution of the service utilization was plotted using ArcGIS Map V. 10 software.

 A total of 258 households (0.77%) used rehabilitation services. Of these, 226 (87%) had a male head, and 32 (13%) had a female head. About 60% had 3-4 members, and 239 (92%) had insurance coverage, and others (8%) had no insurance coverage. Also, 173 (67%) had an employed head. Finally, 55% were living in rural areas, and 45% in urban areas. Uninsured households had less use of rehabilitation services (P<0.05). Also, 1.32% of the fifth income quintile (highest income) used rehabilitation services, while this rate was 0.35% for households in the first quintile (P<0.001). Zanjan, Qazvin, Khuzestan, Isfahan, Lorestan, Bushehr, and Semnan provinces had the lowest service utilization rates in urban/rural areas and the whole country. Qom province had a better status regarding service utilization in urban areas, while East Azerbaijan, Mazandaran, Golestan, Yazd, Fars, and Hormozgan provinces had higher service utilization rates in rural areas. Overall, East Azerbaijan, Mazandaran, and Qom provinces had a higher rate of utilization. The CI value for the whole country was reported at 0.24 (95% CI: 0.17-0.30), indicating a higher inequality in utilization in favor of the rich. The CI values for rural and urban areas were 0.27 and 0.19, respectively (P<0.001).

There is inequality in the utilization of rehabilitation services in favor of the rich households in Iran, and low-income households have lower access to these services. The inclusion of rehabilitation services in the primary health insurance package with appropriate pricing and population coverage, and fair distribution of rehabilitation services following the needs of public and private sectors, can increase the access and utilization of rehabilitation services.

 Pragmatic assessment is critical because of its effective role in social and academic success. It can provide early intervention if the evaluations are made early in childhood. In this regard, an appropriate tool is necessary for the pragmatic evaluation of preschool children in Iran. The checklist of pragmatic behaviors (CPB) is an observational tool for assessing pragmatics in children aged 3-5 years. This study aims to develop a Persian version of the CPB and evaluate its psychometric properties.

This is a methodological study conducted in 2018. The participants were 63 children in three age groups of 3, 4, and 5 years selected from kindergartens in Isfahan City, Iran, using a cluster sampling technique. The inclusion criteria were being 3-5 years old and Persian speaker. This study was conducted in two steps; translation and localization of the CPB to Persian and evaluating the validity and reliability of the Persian CPB. The studied variables were 25 pragmatic behaviors mentioned in the CPB. The test-retest reliability was estimated using 15 children (5 from each age group) in a 2-week interval. Scoring was based on the presence (verbal, nonverbal) or absence of the behavior. The internal consistency was estimated using the Cronbach α coefficient; discriminant validity was assessed concerning age, and criterion validity by measuring the CPB’s correlation with the ages and stages questionnaire (personal-social subscale) and the behavioral problem questionnaire. Nonparametric tests were used for factor analysis and estimating inter-rater agreement and test-retest reliability. The obtained data were analyzed in SPSS 21 and AMOS applications.

 The Persian CPB’s total score significantly increased with the increase of age (P≤0.001). Factor analysis reported four factors for the Persian CPB. Criterion validity evaluation showed the moderate significant correlation of the CPB (r=0.58) with the personal-social subscale of age and stages questionnaire (ASQ), and its weak negative significant correlation (r=-0.28) with the behavior problem questionnaire. A Cronbach α of 0.83 was obtained for internal consistency, and a correlation coefficient of 0.665 (P=0.007) was reported for test-retest reliability.

 The Persian version of the CPB has acceptable psychometric properties. The differences in some items of this version compared to other versions may be because of differences in culture and language.

 Caring for individuals with multiple sclerosis (MS) can affect their caregivers’ occupational performance in various areas such as work, rest/sleep, and social participation. Part of the rehabilitation process is educating caregivers. Primary caregivers need knowledge and information to deliver their caring role. Although face-to-face learning is useful, it can have some limitations. For example, a caregiver should refer to a specific center to receive information and interventions, which is often time-consuming and may trouble them to perform other roles, including their occupational roles. Written health education is used for complementing or strengthening verbal education and maximizing its effectiveness. These materials play an essential role in increasing knowledge, self-management, and commitment to treatment. When health professionals and health services are not available to caregivers, written health education materials can partially answer their questions and needs. It can also help reduce the costs of health care for caregivers. The present study aims to develop and validate the appearance and content of an educational booklet to improve the occupational performance of primary caregivers of individuals with MS (PCIMS).

This is a methodological study conducted. 1. preparing the content based on grounded theory study of PCIMS and their challenges, and then preparing an initial draft, 2. examining the face validity and content validity of the initial draft according to the opinions of 22 experts in MS, and 3. examining the face validity and content validity of the initial draft according to views of 22 PCIMS. An item-level content validity index (I-CVI) value of ≥0.78 and a scale-level content validity index/average (S-CVI/Ave) value of ≥0.9 were considered as the criteria for having acceptable validity in the second and third phases. The binomial test was also used to test the statistical reliability of the I-CVIs at a significance level of 0.05 and the expected proportion of agreement (test proportion) of 0.8.

 The minimum I-CVI and S-CVI/Ave values for the items of a scale designed to assess the face validity and content validity of the booklet were respectively reported 0.9 and 0.97, according to the panel of experts. Also, the minimum observed proportion of agreement for items under the binomial test was obtained 0.9, which was higher than the expected proportion of agreement (0.8). I-CVIs values, S-CVI/Ave value and the observed proportion of agreement between PCIMS were equal to 1. For participating experts and PCIMS, the booklet had appropriate validity, and their comments on the appearance and content of the booklet were applied to the final version of the booklet.

 The developed educational booklet has acceptable face validity and content validity, and specialists can use it for the rehabilitation intervention of PCIMS. Further studies are recommended to investigate the effectiveness of this booklet on improving the quality of life of PCIMS.

 One of the most significant issues in children with attention deficit hyperactivity disorder (ADHD) is emotional/behavioral problems, which disrupt their social communication at home and school. Some of these problems include social problems, rule-breaking behavior, and aggressive behavior. These problems, if left untreated in childhood, can cause problems in adulthood such as substance abuse, insubordination in the workplace, shorter stay at a job, and more anti-social acts. Nowadays, the use of play therapy for children with ADHD has become common. It is an active approach that allows the children to express their feelings through play. In group play therapy, children are asked to evaluate their personality according to their peers’ reactions. The study investigates the effect of group play therapy on emotional/behavioral problems in children with ADHD aged 6-12 years.

This is a randomized controlled trial. The study population consists of all children with ADHD referred to the Dostdaran Koodak Occupational Therapy Clinic in Isfahan City, Iran. Of these, 28 children aged 6-12 years (average age: 8 years), including 8 girls and 20 boys, were selected using a convenience sampling technique. First, the study objective was explained to the parents, and children were then randomly assigned into the intervention and control groups. Considering error (d)=3, with 95% confidence level and 80% test power, the sample size was determined 14 for each group. The intervention group received 12 sessions of group play therapy (2 sessions per week, each for 45-60 minutes), besides two sessions of individual occupational therapy per week. However, the control group received two sessions of occupational therapy per week only. The emotional/behavior problems of subjects in both groups were assessed before and after the intervention using the CBCL. Data analysis was performed in SPSS V. 21 software using the Shapiro-Wilk test and ANCOVA.

 After the group play therapy, there was a significant decrease in the scores of emotional/behavioral problems, including social issues, aggressive behavior, and rule-breaking behavior, as well as in the overall score (P˂0.001).

 Group play therapy can be used as a complementary method with other common occupational therapies for reducing the emotional/behavioral problems in children with ADHD.

The industrialization and alteration of human life structure have led to some serious harms including substance use disorder. Over the past years, various treatment programs have been introduced for the treatment of addiction. The third wave of psychotherapy called Acceptance and Mindfulness based Therapies, came up with the hypothesis that mental harm is associated with trying to control or avoid negative thoughts and emotions. One of the ways to treat problems associated with substance use disorder like impulsivity is Acceptance and Commitment Therapy (ACT). In this regard the study aims to decrease impulsivity in patients with Methamphetamine use disorder by using Acceptance and Commitment Therapy.

The study is a quasi-experimental study with a pretest-posttest-follow-up-control group design.  The study population included all men with Methamphetamine use disorder in2019 currently avoiding any substance use, and all of them were attending narcotics anonymous association sessions in Yazd.  The sampling method was purposeful sampling and the sample size was determined according to the similar studies and also considered to be appropriate for group therapy sessions, ie, 8 to 12 sessions. Thus, among those who scored higher than the cut-point according to Bart's Impulsivity Questionnaire (1994), 12 were randomly assigned to the experimental group and 12 randomly assigned to the control group. Demographic characteristics questionnaire and Barratt Impulsivity Scale (1994) were used to collect data. Inclusion criteria were: 1) Good verbal communication ability 2) Minimum literacy (people able to understand and answer the questionnaire items) 3) Complete abstinence and non-consumption of methamphetamine during at least 6 months before the study. 4) Having passed 6 months after the end of treatment. 5) Being between the ages of 18 and 60 years. 6) Having no mental and physical disabilities (so as not to impede research and evaluation). Exclusion criteria included recurrence and substance use at the time of the study, and addicts with AIDS and Hepatitis C. Descriptive and inferential statistical methods including covariance analysis were used to analyze the data.

The results showed that the value of the parameter (F) belonging to the pre-test variable was 4.9 and it was significant. Therefore, there was a significant difference between the mean scores of impulsivity of the control and experimental groups in the post-test after the pre-test effect was gone  in patients with treated methamphetamine use disorder. The results also showed that the F value of the variable was statistically significant in the post-test. Further, the Wilk’s lambda value was 0.029 with a significance level of 0.000, this means that time has a significant statistical effect. This statistic indicates a difference and change in the impulsivity values of patients with methamphetamine use disorder in patients within the third, sixth and eighth sessions. Also, based on the results, each pair of time periods is compared with each other and indicates that all values ​​with a significant level of less than 0.05 And the impulse rates of patients with methamphetamine use disorder have always been different between the third, sixth and eighth sessions.

Finally based on the results of this study, it can be concluded that Acceptance and Commitment based Therapy as a new and emerging treatment of the third wave of behavioral therapy is a useful intervention for patients with methamphetamine use disorder to reduce their impulsive behaviors.  Given the increasing number of people with addiction, counselors and psychologists need to take non-pharmacological and psychological treatments to address the problems of people with substance use disorder. In particular, Acceptance and Commitment based Therapy for other substance use disorders can also be formulated and implemented to improve relationships between couples with substance use disorder and their relationship with their families.