فصلنامه آرشیو توانبخشی
سال بیست و دوم شماره 1 (پیاپی 86، بهار 1400)

Everyone is required to walk and stand for long time in daily activities, especially in the workplace. As a result, the Ground Reaction Force (GRF) on the components and joints is so great that they sometimes reach several times the weight of the body. These forces can have devastating effects on the feet and ankles. Various studies have suggested different methods and factors for reducing the GRF while walking. The purpose of this study was to identify the different causes of factors and methods affecting the GRF according to the current study. 

This review study was conducted by searching the databases of ProQuest, PabMed, Web of Science, and MBS from 1995 to 2019. The keywords included chr('39')Ground Reaction Forcechr('39'), foot orthosischr('39'), chr('39')walkingchr('39'), chr('39')long term standing impact forcechr('39'). After reviewing the abstract and title of each study by the authors, the criteria for selecting the article were considered. At the control level of each article, based on the main design of the search, from 1 to 5 were scored as randomized control trial, prospective controlled trial (Cohort), case-control, pre/post, observational clinical consensus, respectively. The quality of the articles was evaluated and scored using the Down and Black tool.

Out of 82 articles, 21 articles were selected for analysis based on the criteria. Reporting scores, external validity, and internal validity varied between 4-8, 3-1, 5-2, 6-3, 7-4, respectively. From the studies performed on the molding insoles and the change in the loading rate of the maximum vertical GRF, there is a contradiction in proving it. Investigating the effect of foot orthoses in terms of material may lead to a further reduction in plantar.  

Determining the effect of different components on GRF in the sole of the foot will help us better understand the factors involved in quality of life. The four domains of gender, post, material, and molding had different effects. Due to the lack of articles related to the study of the effect of gender and the creation of posts in the insole on the GRF can not be decisive.

 Spasticity is one of the components of an Upper Motor Neuron (UMN) lesion that occurs usually after a period of flaccidity in the form of velocity-dependent resistance to passive stretch. Spasticity is a significant cause of limited mobility and disability in neurological diseases. There are several clinical approaches to control spasticity. Recently, Shock Wave Therapy (SWT) has been reported to be a new, safe, and effective method for reducing spasticity for people with upper motor neuron lesions. We conducted a meta-analysis of relevant clinical trials to assess the effect of applying SWT on spasticity in UMN lesions. 

An electronic search was performed in PubMed, ISI Web of Science, Scopus, Science Direct, MEDLINE, and Google scholar from January 2005 to January 2020. Studies were included if they measured spasticity with the Modified Ashworth Scale (MAS) or/and neurophysiological indices in patients with stroke, multiple sclerosis, and cerebral palsy. The keywords of muscle hypertonia or spasticity, extracorporeal shock wave therapy, stroke, multiple sclerosis, and cerebral palsy were used. Two independent researchers searched articles, screened eligible studies against the inclusion criteria, and assessed the methodological quality of included studies. The methodological quality of studies was evaluated using the Downs and Black tool. The difference between the means was considered as the effect size in the MAS and Hoffman reflex/motor response (H/M) ratio before and after the intervention with 95% CI in random-effects models. Analyzes were performed using STATA software version 11.

 The initial search led to the retrieval of 98 studies based on the inclusion and exclusion criteria, of which 24 full-text articles were reviewed and 14 articles were included in the meta-analysis process. All 14 articles had examined the effects of shockwave on the MAS. Four studies with 120 patients had examined the effects of shockwave therapy on the H/M ratio. Significant reduction in MAS grade was observed immediately [I2 = 100%, P<0.001, SMD=1.38 with 95%CI: (0.80, 1.87)] and three months after SWT [I2 = 100%, P<0.001, SMD=1.13 with 95%CI: (0.50, 1.76)] in comparison with the baseline values. ESWT had no significant effects on the H/M ratio [I2 = 97.5%, P<0.001, SMD=1.09 with 95%CI: (-0.54, 2.73)].

 SWT can improve spasticity based on the MAS. The lack of SWT effects on the neurophysiological parameter of spasticity supports this opinion that SWT acts on the non-neural component of spasticity. Differences observed in studies in terms of treatment sessions, intervals of treatment sessions, energy density, number of shocks, and follow-up duration need to be examined more closely. More randomized clinical trials are needed in the future to analyze the impact of these factors on the efficacy of SWT for spastic patients.

People with disabilities are highly vulnerable during disasters and their mortality is higher than normal population. The causes of this vulnerability, in addition to the physical problems and movement limitations, can be lack of their knowledge in facing with disasters. Such deficiencies can adversely affect their preparedness surviving in the disastrous situations and cause adverse consequences. Hence, this study aimed to identify the educational needs of people with physical disabilities and related groups in earthquakes, through understanding their views.

The study was done in a qualitative method. Participants were selected from people with physical disability who had an experience of earthquake, literate, and in the age range of 18-60 years, through purposive sampling in two methods of maximum variation and snowballing. Semi-structured interviews were used for data collection and data saturation was reached with the entry of 18 eligible individuals. Thematic analysis was applied for data analysis assisted by MAXQDA software V. 10.

According to the participants, education was an essential factor for improving their preparedness for earthquake. The educational needs were categorized as two main themes. The first main theme included two subthemes: 1. Basic educational needs such as saving life and prevention of secondary disabilities, keeping calm, stress management, and decision making; and 2. Empowerment educational needs such as coping with disabilities in critical situations, providing relief to other people in case of having enough ability, and educating other people with disabilities. The second theme included two subthemes: 1. General educational needs related to families and public, such as rescue of people with disabilities, saving self-life and prevention of disabilities, proper relief to public for prevention of disabilities, accompanying and psychological support of people with disabilities; and 2. The specialized educational needs for relief workers and disaster managers, including relief to people with disabilities, prevention of disability and injury while rescuing public, familiarity with different groups of people with disabilities and their needs, and considering the needs of people with disabilities in the response measures.. 

Based on the findings, the educational needs of people with physical disabilities and related groups, emerged in the form of preserving life, health and disability prevention, empowerment and improving the quality of services in the earthquake. Fulfilling the educational needs can increase the preparedness of these people in facing with earthquakes, although it requires the development of standard and practical educational programs by obtaining their opinions and implementing it in the situations before the disasters. On the other hand, considering that no serious and principled action has been taken so far in the field of education of people with disabilities, it is necessary for the planners and policymakers to formulate specialized policies in accordance with the countrychr('39')s conditions. This measures can be effective in reducing mortality and improving the health of these people in disaster situations.

 Disabled people experience worse situation in respect of the stress, health, and socio-demographic indicators than healthy people. Little knowledge is available about the way in which this disadvantage is patterned by employment status and occupation type, especially in employees with physical disabilities. Few studies have investigated the potential effect of employment status and occupation type on general health and occupational stress in physically disabled employees. This study investigated the role of employment status and occupation type and demographic factors in predicting general health and also, examined the relations between occupational stress and general health while adjusting for demographic factors among employees with physical disabilities in vocational centers of the State Welfare Organization in Tehran City, Iran.

This was a descriptive-analytical study with a cross-sectional design. The study was performed among 273 people with physical disabilities employed in the productive workrooms of vocational rehabilitation centers of Tehran, which were selected via convenience sampling. Data collection tools were Occupational Stress Index (OSI) developed by Belkic (1991) based upon cognitive ergonomics concept to measure the five key potential work-related stressors, Goldberg’s 28-item General Health Questionnaires (GHQ-28) (1979) to detect psychiatric illness as well as current psychological state in the past month and self-administered demographic form. Data analysis was conducted in SPSS software, using the independent t-test, one-way ANOVA and multiple linear regression.

 The Mean±SD age of the physically disabled employees was 33.65 (3.76) years. Most of them were aged 30 to 39 years. (55.2%), men (60.4%), married (60.4%), with part-time employment (67%) and engaged in productive affairs (30%). The relationship between general health and occupational stress with gender and marital status was found to be significant (P<0.05). Women and married subjects had more occupational stress. Moreover, there were significant differences in general health and occupational stress subscales regarding employment status (P<0.05). Part-time employees were exposed to more stressful physical conditions and accidents at work than others, causing a higher level of occupational stress. In addition, employees who were engaged in art-related jobs had higher rate of time pressure, problems and decision-making situations in their workplace, hence, overall more occupational stress. Multiple linear regression analyses were then performed on data to identify general health predictors while adjusting for demographic variables. Age had a significant independent direct effect on enhanced somatic symptoms (β=0.16). Disabled women had a higher score of somatic symptoms than men (β=1.97). Furthermore, part-time employment was directly related to somatic and depression symptoms (β=1.26 and 1.51). Productive works were significantly associated with a higher level of somatic symptoms, anxiety, insomnia and depression symptoms (β=1.28, 1.53 and 1.95, respectively). Therefore, being female, employing as a part-time worker and working in productive affairs were significant predictors of somatic and depressive symptoms in physically disabled employees. Moreover, the physical condition of the workplace, workplace problems and decision-making situations were positively related to somatic symptoms (β=0.7, 0.13 and 0.14, respectively). In overall, 49% of the variance in somatic symptoms (the best model fit) could be explained by independent variables.

 Employment status and occupation type are significantly related to occupational stress, which in turn, causes general health disparities among people with physical disabilities. With respect to the higher level of somatic symptoms and depression in part-time employees, it seems that changing their employment status to full-time, can reduce their stress load and improve their health. In addition, women and married subjects experience more occupational stress and have more somatic symptoms.

 Upperlimb function impairment is one of the most common consequences of stroke and a part of the motor functions, that has been considered as a necessary basis for the implementation of various of occupation and participation. The purpose of the present study is to investigate the relationship between upper extremity function and level of participation and independence in the activities of daily living in people with history of stroke in less than two years ago.

This study is non-experimental and cross-sectional. Among those referring to University of Social Welfare and Rehabilitation Sciences with a history of stroke in less than two years ago, the patients were selected by easy accessible sampling method. Upper limb performance was measured by Fogel-Meier and independency in daily living activities by the Functional Independence Scale (FIM) and participation by the Iranian Participation Questionnaire (IPQ).Data analysis was performed in SPSS V. 23 softwarebyusing Spearman correlation test.

 The results showed that the correlation between upper limb performance and participation was a moderate direct relation (P=0.003, r=0.315) and there was a strong direct (r=0.625, P=0.00)correlation between upper limb performance and independence in activities of daily living.

 The relationship between upper limb function and independence in daily living activities is strong, so with further improvement and efficiency of the upper limbleadtoincreasesindependence in patientschr('39') activities of daily life. The relationship between upper limb function and participation is moderate, so to increase and improve the participation of stroke patients, in addition to upper limb mobility, other factors must be considered.

 Family-centered services are collections for children with special needs and their families. These services consider families as expert about childrenchr('39')s needs. The essence of this approach is involvement of family in decision making, cooperation, and mutual communication (family and therapist), mutual respect, acceptance of family choice, family support, flexibility of service, and effort to empower families. These services have become a basic foundation of many early intervention programs and are especially useful in rehabilitation services. MPOC-20 is one of the questionnaires used to evaluate these services. This questionnaire consists 20 questions divided into 5 areas, the areas include the following: 1) enabling and partnership, 2) providing general information, 3) providing specific information about the child, 4) coordinated and comprehensive care for child and family, and 5) respectful and supportive care. This tool has been translated and validated in several countries and specifically in several diseases. In this study, the validity and reliability of this tool have been investigated.

 This study was a descriptive-analytical and in order to measure the validity and reliability of MPOC-20, content validity, correlation coefficient and reliability of the test-retest were done. To determine the content validity, 14 occupational therapists were asked and the result was calculated by measuring the content validity index and content validity Ratio. Then, an MPOC-20 questionnaire along with a form of demographic information and a consent form were given to 340 parents of children (children under 18 years and with different diagnosis) in clinics of Tehran. The articipants consisted of 142 girls patients (42%) and 198 boys (58%) randomly selected from public and private rehabilitation centers in different regions of Tehran. A large percentage of respondents were mothers (314 people were 92.4%). After 2 weeks, the questionnaire was again distributed among 30 of them, and the ICC coefficients were calculated. In order to determine the internal consistency, Cronbachchr('39')s alpha was calculated.

 The content validity index and content validity Ratio for all items were acceptable and no items were deleted. Cronbachchr('39')s alpha was 0.81 which indicates a high correlation between items in the questionnaire. The highest Cronbachchr('39')s alpha coefficient is related to the field of providing general information about the child (α=0.77). Also, in this section, the p-value was significant for all fields at the level of 0.001. In the reliability of the test-retest, the scores of the Intra-class correlation coefficient of all domains were higher than 0/6 which indicates a medium to good reliability of the questionnaire. Reliability in the field of supportive care had a high coefficient and good reliability. In other areas, the reliability was moderate.

 Considering the importance of evaluation in improvement of family-centered services provision, a strong tool is needed and MPOC-20 is well known in this regard. The results of this study showed that the Persian version of "MPOC-20" questionnaire has a good validity and reliability in children under the age of 18, and it can be used to assess family-centered services in both research studies and as clinical tool.

 This study aimed to translate the Assessment of Interpersonal Problem-Solving Skills (AIPSS) into Persian and to evaluate the validity and reliability of the Persian version of AIPSS to use for adults with schizophrenia.

In this methodological study, the translation process was performed according to the International Quality of Life Assessment (IQOLA) protocol. The face validity of the translated AIPSS was determined based on the opinions of experts and The Content Validity Index (CVI) and Content Validity Ratio (CVR) were also calculated for each item. The Persian version of the test was performed on 52 patients with schizophrenia disorders at Tehran’s Razi Mental Hospital; they were selected using a convenience sampling method. Cronbach’s alpha coefficient was used to evaluate internal consistency. Inter-rater reliability was determined by the Intraclass Correlation Coefficient (ICC). A retest was complete on 15 patients with 2 weeks interval and ICC was used to determine the test-retest reliability.

 Face validity was confirmed by the experts’ opinions. The Content Validity Ratio (CVR) and the Content Validity Index (CVI) were equal to one for all scenes. Cronbachchr('39')s alpha coefficient for all scales was ranged between 0.511 and 0.821. The ICC in all scales were more than 0.98 for inter-rater reliability. In calculating test-retest reliability, the ICC for all scales ranged 0.733-0.893.

 Results show that the Persian version of AIPSS has acceptable face validity, content validity, internal consistency, inter-rater reliability test-retest reliability. Therefore, this instrument can be used in clinical fields and research studies to assess the social skills of Iranian patients with schizophrenia.