Nabil Mahmoud Ismail Abdel-Aal

BACKGROUND AND OBJECTIVE: To investigate the efficacy of adding ultrasound cavitation and radiofrequency versus cryolipolysis to weight reduction program on leptin, insulin, waist circumference, skinfold, body weight in central obese subjects.

MATERIAL AND METHODS: Sixty centrally obese participants were randomly allocated into three equal groups. Subjects in the study group (I) received cavitation and radiofrequency plus dietary regimen, subjects in the second study group (II) received cryolipolysis in conjunction with the same diet program, and subjects in the control group (III) received the same dietary regimen only. Leptin, insulin level, waist circumference, skinfold, body weight, and body mass index were measured shortly before intervention techniques and 3 months afterward.

RESULTS: There were no statistically significant differences between cavitation plus radiofrequency and cryolipolysis on leptin and insulin levels after 3 months of intervention. However, statistically significant differences were found in waist circumference, skinfold, weight reduction, and body mass index in favor of the cavitation group (p < 0.05). In addition, both cavitation-radiofrequency and cryolipolysis were statistically significantly different than the diet alone in favor of the study groups (p < 0.05) in all the outcome measures. Furthermore, there were statistically significant differences in all outcome measures (p < 0.05) when comparing the baseline and postintervention results in each group except for leptin level in the diet group (p = 0.14).

CONCLUSION: Subjects who underwent cavitation plus radiofrequency had better improvement on waist circumference, skinfold, and body mass index than subjects who received cryolipolysis. However, no differences were found between cavitation plus radiofrequency and cryolipolysis on leptin and insulin levels.

OBJECTIVE: To compare the effect of mechanical traction from different knee angles on pain, physical function, and range of motion in patients with knee osteoarthritis.

DESIGN: A single-blinded, randomized controlled trial.

SETTING: Outpatient public and governmental Hospital clinics.

PARTICIPANTS: One hundred and twenty patients with knee osteoarthritis were randomly assigned into 4 equal groups with 30 patients in each group.

INTERVENTIONS: Group (A) received conventional physiotherapy(CPT) treatment; group (B) received CPT with knee traction from full extension, group (C) received CPT with knee traction from 90° flexion, while group (D) received CPT with knee traction from 20° flexion. Interventions were applied 3 sessions a week for 4 weeks.

OUTCOME MEASUREMENTS: Visual analog scale (VAS), knee passive range of motion and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were measured at baseline, immediately after 4 weeks of intervention, and after 4 weeks of no intervention as a follow-up.

RESULTS: After eight weeks, the mean (SD) for VAS scores were 30.97 ± 8.68, 24.0 ± 8.8, 15.43 ± 6.31, and 16.17 ± 6.11 mm; for total WOMAC scores were 26.77 ± 9.19, 20.3 ± 8.52, 13.27 ± 6.25, and 13.43 ± 7.14 for groups A, B, C and D, respectively. The three traction groups showed statistically significant changes in pain scores, physical function, and total WOMAC, but not for knee passive range of motion, in favor of traction groups C and D than the conventional group ( < 0.05).

CONCLUSIONS: Traction from 90°and 20° of knee flexion was found superior to full extension knee in improving pain and physical function, but not for knee passive range of motion, in patients with knee osteoarthritis.

Background: Mechanical Low Back Pain (MLBP) is a major cause of illness and disability, especially in people of working age. Aim of Study: The study was conducted to compare be-tween the effect of aquatic exercise and land-based exercises on pain level, functional disability and lumbar Range of Motion (ROM) in subjects with Chronic Mechanical Low Back Pain (CMLBP). Material and Methods: Sixty patients with chronic me-chanical low back pain of both gender participated in the study: 17 male and 43 female between 25 and 40 years old. They were divided randomly and equally into two groups: A study group (A), in which patients received land based exercise program; and study group (B), in which patients received aquatic exercise program. Both groups received the treatment program for 50min, three times per week, for one month assessment of patients in each group for pain level, functional disability and lumbar range of motion before and after treatment. Results: There were statistically significant differences in all outcome measures in favor of the water exercises group (p < 0.001). In land exercise group, there were statistically significant differences regarding pain intensity, oswestry disability index, and lumbar flexion (p < 0.0001), except for extension, right and left side bending range of motion outcomes (p>0.05). However, there were statistically significant differ-ences regarding all outcome measure in water exercise group (p < 0.0001) when comparing the pre-treatment with post-treatment results. Conclusion: Aquatic therapy is effective in decreasing pain severity, level of functional disability and improved lumbar range of motion in patient with chronic mechanical low back pain than land-based exercise.
Keywords
Low back pain; Range of motion; Disability; Hydrotherapy; Exercise

Objective: To investigate cryolipolysis versus ultrasound cavitation radiofrequency on hunger level, waist-hip
ratio, skin fold, body weight, subcutaneous fat and visceral fat thickness in adolescent with abdominal obesity.
Material and Methods:
Sixty adolescent central obese whose age ranged from 13 to 16 years were allocated randomly into 3 groups. Each of them was 20 participants. Subjects in study group (A) underwent cavitation radiofrequency plus dietary regimen, subjects in the second study group (B) underwent cryolipolysis in conjunction with the same diet program, and subjects in control group (C) received the same diet program only. Patients in all groups were evaluated on height, weight, skinfold, waist-hip ratio, hunger level and MRI were carried out shortly before to the start of the intervention techniques and again two months afterwards.
Results: After two months of intervention, there were no statistically significant differences in BMI, weight, or visceral adipose tissue (VAT) between groups. However, there was a significant difference between the three groups in Suprailiac skin fold, waist-hip ratio, subcutaneous adipose tissue (SAT) and hunger level (P= 0.001) with the Cavitation and radiofrequency group (A) showing better reduction than the Cryolipolysis group (B) and the Cryolipolysis group was better than the diet group (C).
Conclusion:
Cavitation radiofrequency have a favorable effect compared to Cryolipolysis on reduction of skin folds, waist- hip ratio, subcutaneous adipose tissue and hunger level. However, there is no difference between groups on BMI, body weight and VAT.
KEYWORDS: Cryolipolysis, Adolescent Central obesity, Cavitation Radiofrequency, subcutaneous fat,
hunger level.

Open Chain Segmental Control, Closed Chain Segmental Control, Spinopelvic Angles, Asymptomatic Subjects. Purpose: This study aimed to measure of spinopelvic angles after application of open chain segmental control exercises versus closed chain segmental control exercises, pre and post application. Method: Twenty eight participants were randomly divided into two groups, groups A and B. Group A (n=15) received open chain segmental control exercises for four weeks. Group B (n=13) received closed chain segmental control exercises for four weeks. X-Ray and Corel draw software were used to evaluate participants' pelvic angles, pre and post-treatment. Methods: spinopelvic angles were measured before and after treatment in both groups. Spinopelvic angles were pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS) and lumbar lordosis (LL). Results: There were changes in angles of spinopelvic parameters in both groups. The significant difference in pelvic tilt was shown in group "A" while there was a significant difference in pelvic incidence angle in group "B". Conclusion: Both open chain segmental control exercises and closed chain segmental control exercises showed a significance difference before and after application in spinopelvic angles.

Objective: To test the psychometric properties of the translated Arabic version of the foot and ankle ability
measure (FAAM-A) questionnaire in patients with ankle and foot problems.
Design: Methodological study.
Setting: Cairo University hospitals and Egypt sports clubs.
Participants: Thirty experts (3 panels) with 15.6±3.5 years of experience, and 580 patients (16–60 years old) were involved in this research.
Intervention: The English version of foot and ankle ability measure (FAAM) was translated and culturally adapted into Arabic language according to international guidelines. The patients completed the FAAM-A along with the Arabic version of short form 36 (SF-36) questionnaire, and the patients then completed the two questionnaires 1 week later. The intra-class correlation coefficient (95% CI) was used to assess test-retest reliability, while Cronbach’s alpha was used to measure internal consistency reliability. Internal construct validity was assessed by factor analysis while convergent and divergent validity were tested by correlation between FAAM-A and short form 36 questionnaire (SF-36).
Results: FAAM-A has three factorial structures and has a very strong association with SF-36. It has a high internal consistency reliability where Cronbach α of Activity of Daily Living (ADL) subscale was between 0.951 and 0.987 and sport subscale was between 0.968 and 0.971. Test-Retest analysis was 0.984 (0.981-0.986, 95% CI) for ADL and 0.96(0.953-0.966, 95% CI) for sport FAAM total scores (P< 0.0001).
Conclusion: FAAM-A is a reliable, valid, and feasible
Keywords: Psychometrics, Cross-cultural adaptation, Foot and ankle ability measure, Arabic version

Abstract
Abstract Background: Patellofemoral Pain Syndrome (PFPS) is the most prevalent orthopedic condition among physically active adolescents and young adults. PFPS is reported to be between 15% and 25% in young adults. Women are affected about more than twice as often as men. Aim of Study: Investigate the effect of Kinesiology taping, McConnell taping and Open knee brace beside the routine physical therapy in treatment of Patellofemoral pain syndrome (PFPS). Material and Methods: Forty-eight patients (19 males, 29 Females) with unilateral PFPS randomly assigned equally into McConnell tape (MT) group, Kinesiology tape (KT) group, and Open knee brace group (KB). All subjects received interferential therapy, patellar mobilization, quadriceps-strengthening exercise and stretching exercise beside MT or KT or KB. The patients were evaluated by electrogoniometer for knee flexion active range of motion (FAROM), Kujula questionnaire for functional activities and Visual Analogue Scale (VAS) for pain assessment. The evaluation was applied before, after 3 weeks and after 6 weeks of intervention. Results: There was no significant difference between the three groups in VAS, Kujula score and FAROM after three weeks of intervention (p>0.05). After six weeks of intervention, there was a statistical significance in VAS and in Kujula score for MT group (p < 0.05). However, there was no statistically significant difference in FAROM between three groups. There was a statistically significant improvement in VAS, Kujula score and FAROM after three weeks as well as after six weeks of intervention in all groups (p < 0.0001). Conclusion: Adding MT, KT or KB to physical therapy program might be effective in treatment patellofemoral pain, MT was more effective in improving pain and Kujula score, but not for FAROM, than other modalities.
Keywords
Patellofemoral pain syndrome; McConnell tape; Kinesiology tape; Open knee brace

OBJECTIVES: To test the effect of adding neural mobilization (NM) versus myofascial release (MFR) to stabilization exercises (SE) on disability, pain, and lumbar range of motion (ROM) in patients with lumbar spine fusion (LSF).

DESIGN: A single blinded, parallel groups, randomized controlled trial.

SETTING: Outpatient public and governmental hospital clinics.

PARTICIPANTS: Patients (N=60) who had undergone LSF were randomly assigned into 3 equal groups.

INTERVENTION: Group I received NM plus SE, group II received MFR and SE, and group III received SE only. Each group visited the hospital 3 times a week for 4 weeks.

MAIN OUTCOME MEASURES: Oswestry disability index (ODI), visual analog scale, and back range of motion (BROM) were assessed before starting treatment, immediately after finishing treatment, and 1 month later.

RESULTS: There were statistically significant differences among the groups regarding the ODI and pain (P<.05) in favor of the study groups, but no statistically significant differences were found among groups regarding the BROM outcome (P>.05). Regarding the within-group effect, statistically significant differences were found in all outcomes after 1 month of treatment, as well as after 1 month of follow-up in each group (P<.05).

CONCLUSIONS: Patients who received NM or MFR combined with SE demonstrated better improvement, in favor of the NM group, regarding disability and pain than patients who received SE alone after LSF. No differences were found among the groups regarding lumbar ROM.

Objective: To investigate the additive effects of instrument assisted soft tissue mobilization to the conventional physical therapy program on handgrip strength, upper limb functions, and pain in patients with subacromial impingement syndrome.
Design: A single-blinded, randomized controlled study. Setting:Outpatient physical therapy clinic, Cairo University Hospitals.
Subjects: Sixty patients, 25 to 40 years old, with subacromial impingement syndrome, were randomly assigned either into one of two groups: study or control.
Intervention: The study group received the conventional physical therapy for subacromial impingement syndrome plus instrument assisted soft tissue mobilization (IASTM), while the
control group received only the conventional physical therapy. Interventions were conducted three times per week for four weeks.
Outcome measures: Hand grip strength, upper limb functions, andpainwere evaluated at the beginning of the study and after two, and four weeks of interventions.
Results:There were statistically significant differences in hand grip strength, upper limb functions, and pain in both groups after 2 and 4 weeks from intervention in favor of the study group (p< 0.05). After 4 weeks from intervention, M±SD for HG, DASH, and VAS were 31.28±5.19 kg, 7.18±3.44, and 15.0±5.72 mm in the study group, and 21.48±6.87 kg, 16.69±6.67, and 30.67±6.91 mm in the control group, respectively.
Conclusions: Instrument assisted soft tissue mobilization combined with the conventional physical therapy program was more beneficial in improving hand grip strength, upper limb functions, and pain than the conventional physicaltherapy alone. It could be used as a useful adjunctive therapy in management of patients with subacromial impingement syndrome.
Key Words: IASTM, Exercises, Subacromial impingement syndrome, Hand Grip strength.

Background: The most dangerous complications of post-thermal inhalation injury dysphagia are aspiration risks and the inability to efficiently manage solid food textures, which almost persist for weeks and even for months. Objectives: To investigate the effect of transcranial direct current stimulation (tDCS) to conventional therapy for treating post thermal inhalation injury dysphagia. Participants and Methodology: Sixty patients aged from 13 to 35, suffering from post-thermal inhalation injury dysphagia were randomly allocated into two equal groups. The experimental group(A) received 2-mA tDCS through 2 surface electrodes, three times/week for 3 weeks plus conventional physical therapy. While the control group (B) received sham tDCS as a placebo plus the same conventional physical therapy. The Mann Assessment of Swallowing Ability (MASA) as well as Video fluoroscopy Swallow Study (VFSS) were used to assess the swallowing ability in both groups before and after 3 weeks of intervention. Outcome measures included oral transportation time, hyoid elevation, laryngeal elevation, the oesophageal sphincter opens, and aspiration measured by VFSS as well as swallowing ability measured by the MASA. Results: Post-treatment results showed a significant decrease in the oral transportation time, hyoid elevation, laryngeal elevation, the oesophageal sphincter opens, and aspiration, as well as outcomes of the MASA in both groups in favour of the tDCS group(p < .05). Conclusion: Application of tDCS has a significant effect as an adjuvant strategy during swallowing training in patients with post thermal inhalation injury dysphagia.

Keywords
Post thermal inhalation dysphagia; Therapeutic exercises; Transcranial direct current stimulation

OBJECTIVES: To investigate the effects of the Wii Fit rehabilitation program in addition to a standard physical therapy program (SPTP) on lower extremity functional status and functional mobility in adults with severe burns after hospital discharge.

DESIGN: A single-blinded, parallel groups, randomized controlled trial.

SETTINGS: Outpatient rehabilitation center.

PARTICIPANTS: Thirty-four patients (N=34), aged 31.3±7.3 years old, with lower extremity deep partial-thickness and full-thickness burn and total body surface area of more than 40% were allocated randomly into 2 equal groups.

INTERVENTIONS: The Wii Fit group received the Wii Fit program for 30 minutes in addition to SPTP for 60 minutes, whereas the SPTP group received SPTP only. The intervention was 3 sessions a week for 12 weeks.

MAIN OUTCOME MEASURES: The primary outcome measurements were the functional status and functional mobility, which were assessed by the high mobility assessment tool, Lower Limb Functional Index, and timed Up and Go test. The secondary outcomes included exercise capacity, muscle strength, and balance measured by the 6-minute walk test, isokinetic muscle strength assessment, and stability index. All the outcome measures were collected at the baseline and after 12 weeks of intervention.

RESULTS: After 12 weeks of intervention, there were statistically significant differences between groups in all outcome measures in favor of the Wii Fit group (P<.001). Also, statistically significant differences were found in all the measured outcomes after 12 weeks of intervention in each group (P<.05).

CONCLUSIONS: Patients with lower extremity burns who received the Wii Fit program in addition to the SPTP had better improvements in lower limb functional status, functional mobility, exercise capacity, muscle strength, and balance than patients who received SPTP alone. The Wii Fit program was a useful adjunctive therapy in rehabilitating adults with lower extremity burn injury.