فصلنامه آرشیو توانبخشی
سال بیست و چهارم شماره 1 (پیاپی 95، بهار 1402)

Schizophrenia is the most debilitating psychiatric disorder with the highest psychiatric ward admission rate. Drug therapy is the first line of treatment. However, it does not result in appropriate therapeutic responses in many patients, and they experience emotional regulation difficulties and psychosis symptoms after initial symptom resolution. Cognitive-behavioral therapy (CBT) is currently an adjuvant treatment besides drug therapy to target the persistent symptoms of psychosis. The present study aims to determine the effectiveness of CBT on the positive and negative symptoms and emotional regulation of those suffering from schizophrenia spectrum disorders.

The research design was single-subject and of the AB type (baseline and intervention) with a follow-up phase. Besides the routine therapy sessions, CBT sessions were held for the study participants. They were patients admitted to Razi Educational and Therapeutic and Research Psychiatric Center in Tehran City, Iran, who were selected based on the inclusion criteria. Thirty patients were selected with convenience sampling, and 5 were randomly placed in the CBT group. They were evaluated with the scales of positive and negative symptoms of Kay, Fiszbein, and Opler (1986) and difficulties in emotional regulation by Gratz and Roemer (2004) in the baseline, intervention, and follow-up phases. The treatment sessions were planned based on the CBT protocol developed by Laura Smith, Paula Nathan, Uta juniper, Patrick Kingsep, and Louella Lim (2003). Non-overlap of all pairs (NAP), percentage of non-overlapping data (PND), percentage of all non-overlapping data (PAND), percentage of data points exceeding the median (PEM), Cohen’s d effect size, and improvement percentages were used to analyze the data, and visual graphs were used for data presentation.

The outcomes showed that in the intervention phase, compared to the baseline phase, the effect sizes of the positive and negative symptoms in the first to fifth participants were 1.6, 3.1, 3.2, 1.9, and 2.4, respectively. Only the effect sizes of the second and third participants were large. The effect sizes of the emotional regulation factor in the first to fifth participants were 2.8, 1.2, 1.1, 2.2, and 1.9, respectively. The effect size of the second participant was large, and the rest were average. The findings of this study showed that during the post-therapy and follow-up stages, while patients who had received CBT still experienced positive and negative symptoms of psychosis and difficulties in emotional regulation; these symptoms decreased in comparison with the baseline phase. Furthermore, their improvement percentages were not significant.

n Data analysis showed that although CBT is effective in reducing positive and negative psychotic symptoms and improving the emotional regulation of patients, the data obtained from Cohen’s d effect size and recovery indices showed that the results are not clinically significant. In other words, although the patients who received CBT showed a slight improvement in psychotic symptoms and difficulty in emotional regulation, they could not maintain the therapeutic gains in the follow-up phase.

Objective:

 Post-traumatic stress disorder (PTSD) is one of the anxiety disorders caused by a specific event, which can be catastrophic events (natural disasters, war, imprisonment in a forced labor camp) or everyday adversities (death of relatives, divorce, carrying bags). Since patients who have recovered from COVID-19 are exposed to such events, this research was conducted to determine the prevalence of PTSD in this group.

This study was cross-sectional. The statistical population included all patients who recovered from COVID-19 between November 2021 and February 2022 in Hamedan City, Iran; based on Krejcie and Morgan’s sample size table, 185 patients were selected by simple random sampling method. The research tool was the demographic questionnaire and the Mississippi post-traumatic stress disorder questionnaire (Mississippi PTSD); the data were analyzed using the Mann-Whitney and Kruskal-Wallis tests.

The results showed that the Mean±SD score of PTSD was 80.37±17.37 in the subjects who recovered from COVID-19. The relationship between the demographic variables of gender (P=0.01), education (P=0.039), occupation (P=0.24), marriage (P=0.62), age (P=0.048), weight (P=0.047), height (P=0.023) with PTSD were reported.

The results showed that 76.2% of people who recovered from COVID-19 were exposed to PTSD with moderate and high severity; therefore, techniques to reduce anxiety from the coronavirus are recommended.

Osteoarthritis is one of the most common knee joint diseases. It is a multifactorial, inflammatory, and destructive disorder of the joint that involves the synovial tissues and joint cartilage and causes permanent pain, functional limitations, and a decrease in patients’ quality of life (QoL). In advanced cases of the disease, total knee arthroplasty is performed to reduce pain and improve the function of the patients. The presence of pain after this surgery is a major concern that reduces the QoL of these people. One of the causes of pain after surgery is extra-articular pain and involvement of the musculoskeletal system, the most common cause of which is pain caused by active trigger points. Dry needling is one way to deactivate trigger points. This study aimed to investigate the effects of dry needling on the pain intensity and function of patients with active trigger points in the muscles around the knee after total knee arthroplasty.

This research was a before-and-after clinical trial study. In this study, 49 patients aged 55 to 80 years, with at least 3 months past their total knee arthroplasty and still having pain, were included by an orthopedic specialist after reviewing the inclusion and exclusion criteria. After the first researcher considered the inclusion and exclusion criteria and the presence of active trigger points in the muscles around the knee, including the quadriceps, hamstring, and gastrocsoleus, 27 patients were qualified. The amount of pain in these patients before, one week, and one month, after dry needling was measured and compared based on the linear visual analog scale. Also, the performance of the patients was assessed based on the knee injury and osteoarthritis outcome score questionnaire. This study aimed to investigate the short-term effects of dry needling on pain intensity and function of patients with active trigger points in the muscles around the knee after total knee arthroplasty.

The results of this study show a significant difference (P<0.001) between the amount of pain before dry needling (57.2±8.9) and one week after dry needling (10.8±33.6). Also, there is a significant (P<0.006) difference between the performance of patients before dry needling (47.5±11.9) and one week after dry needling (42.3±10.6). No significant difference was observed regarding pain and performance between one week and one month after dry needling.

Performing one dry needling session on the active trigger points of the muscles around the knee after total knee arthroplasty reduces pain and improves patients’ performance.

There are so many people with disabilities worldwide. This condition has led to taking various national and international measures regarding the rights of people with disabilities. Protecting the rights of people with disabilities in the context of international methods is an important issue that has been explored for years. This study aims to explain the dimensions of the rights of people with disabilities in Iran.

In this study, the meta-synthesis method was used, and the statistical population of the research articles was extracted from various research databases, such as Magiran, Normgaz, Regional Information Center for Science and Technology, Science Net Database, Nematan, Civilica, and Humanities Portal were selected. In this study, based on the inclusion criteria, such as title, abstract, content, and quality assessment of studies, 14 articles were finally selected for study analysis. In addition, the time frame of this research is from 2009 to 2020. Also, this study used the 7-step method of Sandelowski and Barros (2007) to analyze the research data.

The most important rights of the disabled are employment, human value and dignity, education, belonging, proper design of urban furniture, access to health services, elimination of social discrimination, recreation and leisure, social security, freedom, and transportation. By reviewing and integrating the initial findings in this study, after going back and forth between sub-fields, 7 main fields of disability rights were obtained: cultural, economic, political, architectural and urban rights, social, medical, and legal rights. This study examined the content validity ratio and content validity index. The opinions of 8 experts in this field have been used to calculate this ratio. Concerning the content validity ratio, it should be said that it was acceptable for all dimensions. The Kappa index has been used to measure the reliability of the designed model; the kappa coefficient is calculated to be 87%, which is at a high level of the agreement due to the status of the kappa index.

Legally, people with disabilities have cultural, economic, political, architectural, urban, social, medical, and legal rights. Different and negative views of managers and individuals in society have led to disregarding the rights of people with disabilities. Lack of proper knowledge about people with disabilities and subsequent marginalization will have negative consequences. Proper knowledge of this phenomenon and awareness of the capabilities of people with disabilities is an effective step toward developing a country. Most people with disabilities have been deprived of their basic social, economic, political, and cultural rights. In this regard, pervasive stereotypes, attitudes, and discrimination have reinforced this injustice. It is worthwhile that by changing the perspective of the international community, government, and citizens, able-bodied people can live a just life alongside others. The Iranian government can assist people with disabilities in enacting and enforcing various laws on the rights of persons with disabilities.

Knee osteoarthritis is one of the most common musculoskeletal disorders affecting balance. It is also a risk factor for falling in older people. People with a history of falling, whether being injured or not, acquire a fear of potential falling, so they limit their functional activities, leading to decreased mobility, muscle weakness, and increased risk of falling in the future. Evaluating the relationship between balance and fear of falling in these patients can detect the disability mechanisms and falling and also help find more effective therapeutic methods for these patients. Some previous studies evaluated the stability of patients by clinical methods in static situations and related it to fear of falling. However, the walking stability of patients was not assessed by laboratory-based systems in previous studies. Therefore, we aimed to evaluate dynamic (during walking and based on the center of mass sways) and static stability (based on the center of pressure sways) and their relationship with falling risk in patients with knee osteoarthritis.

This is a descriptive cross-sectional study. A group of 15 subjects with mild to moderate knee osteoarthritis with a Mean±SD age of 50±3.22 years and 15 normal subjects with comparable age, height, and weight participated in this study. The subjects’ standing stability was evaluated using a Kistler force plate based on mediolateral (ML) and anteroposterior (AP) displacements of the center of pressure. Also, the dynamic stability of the subjects was evaluated during walking and based on the center of mass-base of support relationship in AP and ML directions. Kinematic data were collected using a motion analysis system with 7 high-speed cameras and a Kistler force plate. To model the body segments, the output of Qualisys track manager software was exported to Visual 3D software. Fear of falling was assessed by the native version of the fall efficacy scale (FES-I). The normal distribution of data was checked by the Shapiro-Wilk test. The independent samples t-test was used to compare the stability of patients and normal subjects. The Pearson correlation coefficient was used to evaluate the relationships between static and dynamic stability parameters and fear of falling in patients with knee osteoarthritis.

Patients with knee osteoarthritis had less stability during standing and walking than healthy subjects (P<0.05). Moreover, based on the results of this study, there was a linear relationship between the center of body pressure (COP) excursions in the AP direction and the fear of falling scale. Still, it was not significant (r=0.416, P=0.123), and there was no correlation between the other COP parameters with FES (r=0, P>0.05). The correlations between mean center of mass (COM) excursion in AP and ML directions and FES were 0.309 and -0.123, respectively; however, these correlations were also not statistically significant (P>0.05).

Based on the results of this study, there is no significant relationship between static and dynamic stability of the patients with mild to moderate knee osteoarthritis (based on COP-COM variables) and the fall efficiency scale. So, it seems that to improve these patients’ functional abilities, and the therapists must focus on the other parameters that affect the falling, such as reducing pain, improving proprioception, and enhancing muscle strength. It is suggested that future studies include a more varied age range of elderly people and evaluate all contributing factors in falling of patients with knee osteoarthritis (such as pain, proprioception, vision, and muscle strength) and also evaluate the stability of patients with both laboratory-based and clinical tests.

Because of the increasing number of people with disabilities and the lack of awareness of disability prevention methods in developing countries, creating a proper rehabilitation structure and providing appropriate services are among the important goals of every health system. Conducting comparative studies is one of the research methods for reviewing the structure of the rehabilitation system in the country’s health system. This study aimed to compare the rehabilitation structure in Iran with 5 other countries.

This research is a comparative study conducted in 2022. In this study, sampling was purposeful. Five countries of Germany, Japan, Canada, Turkey, and South Africa were compared in terms of organizational and health management, financial and legal components, and social policy components with Iran. Reliable databases and related resources in the rehabilitation structure were used to collect data. In this study, the obtained data were analyzed using the Bereday model containing four stages: Description, interpretation, proximity, and comparison. The findings were evaluated in a comparative table.

The findings indicated that in terms of organization and health management, the Ministry of Health should be responsible for health management and rehabilitation, but in Iran, in addition to the Ministry of Health, the Red Crescent, the Martyr Foundation, and Exceptional Education Organization are also involved in the management of rehabilitation. Financial issues and problems are significant barriers for people with disabilities to access rehabilitation services in these countries. In Iran, a large part of these costs is paid from the pockets of families. Regarding legal components in Iran, as in other countries, specific rules exist to provide services to people with disabilities. But sometimes, these rules are not properly implemented. From the sociodemographic perspective, Iran has an aging population, welcomes immigrants, and holds diverse cultures. The access of all people in need of rehabilitation in this diverse population to the services needed is limited. In terms of policy components, regulating national health policy requires review and, if necessary, changes in existing health system policies.

The existence of a specific position for rehabilitation in the Iranian health system, provision of services, and management of rehabilitation affairs by a single organization such as the Ministry of Health, as well as proper implementation of laws and policies, can lead to structural improvement and management of the health system and rehabilitation. Financial obstacles and problems to rehabilitation services should be reduced, and government and insurance must cover most of the costs of rehabilitation services. Also, a review of national health policies and legislation in the country should be done to improve the access of all people with disabilities to health and rehabilitation services. Therefore, it is necessary to fundamentally review and reform the structure, value, and process of providing rehabilitation services.

Today transoral laser microsurgery is considered as one of the first options to control early laryngeal cancer, and voice disorder is one of the inevitable complications of this therapeutic component. This study aimed to compare the vocal function in patients with early-stage laryngeal cancer following laser surgery with healthy individuals with normal voice quality using acoustic analysis and the voice handicap index and to examine the correlation between the results of these two evaluations in each group.

The current research is a descriptive-correlational and comparative study that was cross-sectioned using convenience sampling into two groups consisting of 60 men (Mean±SD of age 59.18±5.170 years) with early laryngeal cancer undergoing laser surgery as a patient group and 60 men (Mean±SD of age 56.68±5.491 years) with normal voice quality, and without any history of voice disorder as a control. The vocal function of participants was assessed using acoustic parameters (including jitter, shimmer, harmonic to noise ratio, fundamental frequency, smoothed cepstral peak prominence) and a 30-item Persian version of the voice handicap index questionnaire (including overall score and scores of physical, emotional and functional subscale). Then, data were analyzed using SPSS software, version 20, descriptive statistics, Kolmogorov-Smirnov, independent t-test, and Pearson correlation coefficient at the P<0.05.

The results show that the acoustic parameters and voice handicap index in the group undergoing laser surgery are significantly different from the control group (P<0.001). Also, a significant direct correlation between jitter and shimmer with total score and physical subscale of VHI, a significant inverse correlation between the harmonic-to-noise ratio and total score, functional and physical subscales of VHI, as well as between smoothed cepstral peak prominence with total score and all subscales of VHI (P<0.05). In addition, in the control group, there is no significant correlation between the acoustic parameters and the subscales of the voice handicap index (P<0.05).

The findings of the acoustic analysis and the voice handicap index show impairment in vocal function and a decrease in voice-related quality of life (QoL) in patients with early laryngeal cancer after laser surgery. Furthermore, a significant correlation between the scores of the voice handicap index and acoustic analysis parameters, especially cepstral analysis indicates the necessity to pay attention to frequency-based analysis. Therefore the results of the present study emphasize the need for a comprehensive assessment of vocal function, providing voice therapy programs, and attention to psychological problems in patients with early laryngeal cancer after laser surgery.

The physical and hormonal changes occur in pregnant women, which may cause skeletal and muscular discomforts and back and pelvic pain. If the pelvic muscles mechanism is damaged, pelvic joints may have less stability, and the joint is more exposed to shearing force. As a result of this condition, the activity pattern of these muscles of the lumbar region may change, increased muscle activity compensates for the anterior forces, and bending moments may occur, especially when the abdomen volume is increased. In previous studies, the activity of pelvic muscles in the test of active straight leg raise (ASLR) was evaluated in pregnant women without using a pelvic belt. These belts are strapped at the level of the pelvic ring and do not fully support the lumbar region. The lumbar-pelvic belt can extend below the lower angle of the scapula, completely covering the lumbar region and supporting the waist and pelvis simultaneously. As a result, the whole body acts as a unit compared to a pelvic belt. The present study aims to compare the effect of the lumbar-pelvic belt with the pelvic belt in the activity of the pelvic muscles during the ASLR test of the lower limb in pregnant women with back and pelvic pain.

This was a clinical trial study on 48 pregnant women with pregnancy-related back and pelvic pain referred to the Kawsar Specialized and Subspecialty Clinic in Arak City, Iran. The sampling method was convenience sampling based on inclusion and exclusion. All participants completed the written consent form, and then they were randomly divided into three groups: lumbar-pelvic belt (14 women), pelvic belt (14 women), and control (20 women). First, a demographic questionnaire was completed by the participants. Then the pelvic muscles’ muscle activity was evaluated using surface electromyography during the ASLR test at the beginning of the study and then three weeks later. Covariance analysis was used in SPSS version 26 software for data analysis, and the significance level was considered 0.05.

After three weeks of using the devices, the activity of the right rectus femoris, left rectus femoris, right biceps femoris, and left biceps femoris muscles decreased in both groups who used the belts and increased in the control group during the ASLR test. The activity of the right biceps femoris and left biceps femoris muscles in the lumbar-pelvic belt group was significantly reduced compared to the pelvic belt group (P<0.001). Although the activity level of the right rectus femoris and left rectus femoris muscles in the lumbar-pelvic belt group decreased more than the pelvic belt group, this decrease was not statistically significant.

The activity of the rectus femoris and biceps femoris muscles during the ASLR test decreased in both groups using the pelvic belts and increased in the control group after three weeks. This finding shows the effect of both pelvic belts on improving pelvic muscle activity. However, the lumbar-pelvic belt had a greater impact on improving the activity of the biceps femoris muscles than the pelvic belt during the ASLR test.