Iranian Rehabilitation Journal
Year:2025 | Volume:23 | Issue:3|Papers Count:13

Similar to many other nations, Iran is committed to achieving universal health coverage, which includes the provision of accessible and high-quality rehabilitation services. Consequently, several legislative measures have been enacted to regulate the sector. However, a closer examination of these laws reveals numerous systemic challenges that impact critical health system functions, such as procurement, financing, resource allocation, service delivery, accountability, and overall quality.

I am writing this letter to highlight the profound significance of facial rehabilitation surgeries for patients who have endured the debilitating effects of stroke. This practice, deeply rooted in evidence-based clinical rehabilitation, serves as an alternative modality for patient intervention following cardiovascular accidents.

Objectives: Scoliosis is a three-dimensional deformity of the spine that can be treated using various treatment approaches. The use of braces is one of the most commonly used treatment methods for controlling curve progression. This study aimed to evaluate the effectiveness of the Milwaukee brace (MB) in controlling scoliosis curve progression, based on available literature. Methods: This study was conducted using several databases, including ISI Web of Science, PubMed, Google Scholar, Ebsco, and Scopus. Some keywords, such as MB, were used in combination with Milwaukee orthosis and scoliosis. Down and Black tool evaluated the quality of the studies. Results: Based on the keywords, 18 papers were selected, including 11 on the efficiency of MB, three on psychological issues and quality of life (QoL), one on the combination of exercise and brace, and three on the comparison between braces. The quality of the studies ranged from 6 to 18. Various studies have shown that MB controls the progression of the curve in scoliosis deformity and influences the natural history of scoliosis. Discussion: The results of various studies confirmed that although MB controls the progression of scoliosis curve, it is not comparable with other available braces, which may be due to the mechanism of action. It is recommended that, due to the advantages of MB, a combination of transverse and traction forces be used to control and decrease scoliosis deformity.

Objectives: This study aimed to translate, culturally adapt, and psychometrically validate the Persian version of the upper limb functional index (ULFI) in Iranian patients with upper limb musculoskeletal disorders. Methods: A cross-sectional study was conducted with 200 Iranian outpatients diagnosed with upper limb musculoskeletal disorders. The translation and cultural adaptation process included forward translation, back-translation, expert panel review, and pilot testing. Psychometric evaluation involved internal consistency (Cronbach’s α), test, re-test reliability (intraclass correlation coefficient [ICC]), construct validity (convergent validity with the disabilities of the arm, shoulder, and hand [DASH] questionnaire), confirmatory factor analysis (CFA), and responsiveness. Results: The Persian ULFI exhibited excellent internal consistency (Cronbach’s α=0.91) and high test re-test reliability (intraclass correlation coefficient [ICC]=0.88, 95% CI, 0.82%, 0.93%). Convergent validity was confirmed through a strong correlation with the DASH questionnaire (r=0.76, P<0.001). CFA supported a unidimensional structure, with fit indices (comparative fit index [CFI]=0.96, Tucker-Lewis index [TLI]=0.95, root mean square error of approximation [RMSEA]=0.06, standardized root mean square residual [SRMR]=0.04). Responsiveness analysis demonstrated significant improvement after rehabilitation (effect size=0.89, standardized response mean [SRM]=1.12, P<0.001). Discussion: The Persian ULFI is a valid, reliable, and responsive tool for assessing upper limb function in Iranian patients. It can be effectively used in clinical settings and research to evaluate rehabilitation outcomes and functional impairment.

Objectives: The theory of gerotranscendence offers a framework for understanding the profound psychological shift that often accompanies aging, characterized by a movement away from materialistic and pragmatic worldviews towards a more cosmic, transcendent perspective. This transition is characterized by shifts in values, attitudes, and behaviors, emphasizing spiritual fulfillment, introspection, and deeper acceptance of life’s mysteries. This study aimed to investigate the relationship between gerotranscendence and life satisfaction among Iranian older adults, offering insights into the potential role of this perspective in promoting well-being in later life.  Methods: This study employed a population-based, cross-sectional analytical-descriptive design to investigate key psychosocial variables among older adults. A total of 183 individuals aged >60 years and residing in Kerman City, Iran, were recruited through cluster sampling to ensure representative coverage across the region. Data collection involved the administration of two psychometrically validated instruments, the gerotranscendence scale (GS-S) and the life satisfaction index-Z (LSIZ), along with a structured socio-demographic questionnaire to capture participants’ background characteristics. Results: Of the participants, 127(69.4%) were married, and 99(54.1%) were female, with a mean age of 66.7±7.14. The findings indicate a statistically significant positive correlation between overall gerotranscendence scores and life satisfaction (P<0.01, r=0.357), with each dimension of gerotranscendence contributing uniquely to this association. Multiple linear regression analysis revealed that gerotranscendence explained 20.3% of the variance in life satisfaction scores, underscoring its potential as a predictor of well-being in older adults.  Discussion: This study underscores the significance of cultivating a gerotranscendent perspective to enhance life satisfaction among older adults. Policymakers and practitioners should consider integrating gerotranscendence principles into health promotion initiatives, intervention programs, and care planning strategies for older adults. Such an approach may not only enhance individual well-being but also support holistic and culturally sensitive aging policies.

Objectives: Numerous studies have documented the effectiveness of play therapy in helping children modify their thoughts and behaviors. This study aimed to determine the efficacy of cognitive-behavioral play therapy (CBPT) in addressing internalizing problems in children aged 8–10 years.  Methods: This quasi-experimental study employed a pre-test and post-test design with a control group, involving 391 students selected through cluster sampling. Students were assessed using the child behavioral checklist (CBCL), multidimensional anxiety scale (MASC), and child depression inventory (CDI). Among 153 students whose scores were T≥63 in CBCL, ≥60 in MASC and ≥18 in CDI, 42 individuals diagnosed as having internalizing disorders through the psychiatric interview and assigned randomly and equally to the experimental and control groups. The experimental group attended 14 therapeutic sessions (once a week, 45 minutes each session) and received CBPT, but the control group did not. After the last session, all participants were reassessed using the CBCL, MASC, and CDI. Data were analyzed using multivariate analysis of covariance (MANCOVA). Results: The results showed that the internalizing behavior problems of the experimental group reduced after attending CBPT sessions. According to the eta coefficient, 40%, 69%, 69%, 72%, 55%, and 62% of the variation in internalizing behavior problems and their factors (anxiety/depression, withdrawal/depression, somatic complaints [SC]), anxiety, and depression in the experimental group were due to participating in CBPT. Discussion: It can be concluded that the CBPT is a useful therapeutic technique to reduce internalizing behavior problems and their negative effects on academic performance in 8–10-year-old children.

Objectives: Dentists are exposed to musculoskeletal disorders (MSDs) due to the nature of their work, which can impact their ability to provide effective patient care. This study aimed to investigate the effects of ergonomic interventions on reducing cervical and lumbar spine among dentists. Methods: This interventional study was conducted in 2022 among dentists at educational clinics of the universities of medical sciences in Tehran City, Iran. Data were collected using demographic questionnaires, Neck disability index, the Oswestry disability index, and the visual analog scale (VAS). Comprehensive educational content, including training in ergonomic principles, sports, and behavioral health, was used. Data were analyzed using SPSS software, version 22 at two levels: Descriptive and analytical statistics. Results: The research participants were 81 dentistry students with an average working experience of 3.14±1.58 years (Mean±SD). Among the participants, 32(39.5%) were male and 49(60.5%) were female. The results of the paired t-test showed that the interventions (education and exercise) were significantly effective, such that the amount of neck pain, as measured by the neck disability index level, decreased by 4.44, and in the VAS level decreased by 16.17 (P<0.001). Similarly, the reduction in waist pain for the disability index was 4.98, and for VAS, it was 8.76 (P<0.001). Discussion: Based on the results of this study, ergonomic interventions (educational and exercise) can improve working conditions, prevent disorders, and reduce neck and back pain in dentists. Therefore, it is necessary to implement preventive measures, such as ergonomic interventions and ongoing training, to minimize MSDs among dentists.

Objectives: This study aimed to understand the screen time activities of toddlers and their parents, the relationship between toddlers’ screen time and socioeconomic status (SES), the relationship between toddlers’ screen time and language skills, and the screen time restrictions set by their families. Methods: The participants comprised 33 typically developing toddlers aged 12-24 months and their parents. Informed consent was obtained from the parents of all participants who passed the screening. Children’s and their parents’ screen time activities and other leisure activities, the family’s SES, and receptive and expressive language scores were assessed.  Results: A total of 96.9% of children had a mean screen time of 750 minutes per week, equivalent to 1.8 hours per day, which is significantly higher than the recommended guidelines. Children were mostly exposed to smartphones and televisions. Nine children did not meet age-appropriate language scores, and all other children had age-appropriate language scores despite having excess screen time. No significant correlation was found between language scores and screen time in children and parents. A positive correlation was found between parents’ screen time and SES, but not between children’s screen time and SES. Discussion: This study highlights the significance of co-viewing and interactive screen time in supporting the development of language skills. It also highlights the need to revise guidelines on screen time restrictions in young children. Guidelines should include recommendations in choosing high-quality, age-appropriate strategies to encourage co-viewing to enhance parent-child interaction. The paper also emphasizes the significance of restricting parents’ screen time as it may interfere with qualitative interactions with the child leading to language delay.

Objectives: Diabetes is a major global health challenge, requiring effective self-management and medication adherence to achieve optimal outcomes. Health literacy, which includes the ability to understand and apply health information, mediates these behaviors. This study aimed to investigate the mediating role of diabetes health literacy in the relationship between self-management practices and medication adherence among patients with diabetes. Methods: This correlational study was conducted at the Babylon Diabetes and Endocrinology Center, and 328 patients with diabetes were selected by convenience sampling. Data were collected using the diabetes self-management questionnaire (DSMQ), medication adherence report scale (MARS), and diabetes health literacy scale (DHLS). Validity and reliability were confirmed by expert reviews and pilot testing (Cronbach’s α>0.80). Statistical analysis included Pearson correlation and simple linear regression. Results: The mean age of the participants was 45.35±9.38 years, and 56.1% were female. Moderate levels of self-management (63.1%, 34.44±5.35) and health literacy (46.3%, 28.12±5.86) were observed, while 58.8% showed good adherence to medications (25.87±3.36). Regression analysis revealed that diabetic health literacy was a significant predictor of diabetes self-management (β=0.625, P<0.001) and medication adherence (β=0.580, P<0.001). Discussion: Health literacy is a strong predictor of improved diabetes self-management and medication adherence, underscoring its critical role in diabetes management outcomes. Healthcare providers should integrate structured health literacy programs, streamline communication, and provide personalized support to empower individuals with diabetes.

Objectives: This study aimed to examine the prevalence of pain, motor, and cognitive impairments, as well as the comorbidities associated with them, among older adult patients with stroke at the Osun State University Teaching Hospital in Osogbo City, Nigeria.  Methods: This cross-sectional study involved a survey of older adult patients with stroke receiving care at Osun State University Teaching Hospital. The prevalence of different post-stroke symptoms was assessed using validated instruments.  Results: This study included 261 stroke survivors with a mean age of 69.4 years. The majority of them had pain (70.1%), balance impairment (93.9%), and mild cognitive impairment (80.8%). The prevalence of these symptoms varied by age, sex, and education level. Participants aged ≥75 years had lower odds of having pain than those aged 55-64 years (odds ratio [OR]=0.34, 95% CI, 0.15%, 0.76%, P=0.01), and the Hausas and Igbos had lower odds of having pain compared to their Yoruba counterparts (OR=0.24, 95% CI, 0.07%, 0.78%, P=0.02; OR=0.25, 95% CI, 0.07%, 0.88%, P=0.03). Male participants were significantly less likely to have cognitive impairment than female participants (OR=0.43, 95%, 0.21%, 0.87%, P=0.02). No significant correlation was found between balance impairment and the other variables.  Discussion: This study revealed a high prevalence of pain, balance impairment, and mild cognitive impairment among older adult patients with stroke in Nigeria. These symptoms may affect stroke survivors’ ability to regain function and overall health. The findings also suggest that age, sex, and education level may influence the occurrence and severity of these symptoms. This study reported a high prevalence of pain, balance impairment, and mild cognitive impairment among older adult patients with stroke in a teaching hospital in Nigeria. The findings also indicated that age, sex, and education level may influence the likelihood of these symptoms among stroke survivors. Therefore, this study suggests that more attention should be given to the assessment and management of these symptoms to enhance the quality of life and functional outcomes of stroke survivors.

Objectives: To test the effectiveness of proprioceptive neuromuscular facilitation (PNF) on muscle strength, spasticity, functional mobility, and range of motion (ROM) in hemiplegic patients with foot drop. Methods: This was a single-arm, pre-post study of 30 adults (21–60 years) with hemiplegic foot drop receiving a 14-week PNF. The interventions included contract-relax stretching, resistance training (D1/D2 diagonal patterns), and functional exercises. The assessed outcomes were muscle strength, spasticity, ankle dorsiflexion ROM, and functional mobility. Results: Following the intervention, all outcomes significantly improved. Tibialis anterior (TA) strengthened grade 2 to 3 (P<0.001, r=0.62), and 42% achieved grades 4–5. There were large effect sizes for the quadriceps, hamstrings, and calf muscles (r=0.51–0.62). TA spasticity dropped from grade 3 to 2 (P<0.001, r=0.75), and 68% reached grade ≤2. Functional mobility improved by 5.21 cm (P<0.001, r=0.83), and ankle dorsiflexion ROM increased by 8.5° (P<0.001, r=0.52). Discussion: Diagonal patterns and resistance training decrease the degree of spasticity and increase strength and mobility, making it possible to use this PNF type even in comparison to shorter-term protocols. These findings support the use of PNF to address foot drop in stroke rehabilitation.

Objectives: This study aimed to compare the relationships between executive functions (EFs), manual dexterity, and instrumental activities of daily livings (IADLs) in older adults with mild cognitive impairment (MCI) and cognitively healthy controls to identify targets for early interventions and slowing cognitive decline. Methods: This case-control study included 64 adults aged ≥60 years (32 with MCI, 32 controls), without depression (geriatric depression scale [GDS]-15 <9), recruited from a geriatric clinic and a day care center. MCI was diagnosed using the Persian version of the clinical dementia rating (CDR). EFs were assessed using the Tower of London (ToL), Wisconsin card sorting test (WCST), and trail making test (TMT-A&B); manual dexterity with the Purdue Pegboard test (PPT); and IADLs with IADLs-Lawton. Data were analyzed using SPSS software, version 27.  Results: No significant differences in age and sex were observed between the MCI (mean age: 68.88±5.08) and control groups (70.5±5.42) (P>0.05). The MCI group showed poorer performance in the ToL, WCST, and TMT-A&B (P<0.001), and performed worse in the PPT (P<0.001). Additionally, they had lower IADL scores (P<0.001). Better EFs correlated with improved manual dexterity and higher IADL scores (r=0.42 to 0.53, P<0.05) in the MCI group. Longer ToL/TMT times and WCST errors were linked to poorer PPT/IADLs performance (r=-0.35 to -0.69, P<0.05) in the control group. Discussion: Older adults with MCI demonstrated significant declines in EFs, manual dexterity, and IADLs compared to cognitively healthy controls. These results highlight the importance of assessing cognitive and motor abilities to facilitate early interventions and support independence. Combining cognitive and motor education programs with caregiver training can effectively address these challenges.

Objectives: This study aimed to quantify anxiety levels among post-ischemic stroke patients in Babylon Governorate, Iraq, and establish a correlation between anxiety severity and sociodemographic/clinical factors. Methods: A cross-sectional study was conducted among 100 post-ischemic stroke patients at Al-Imam Al Sadiq Teaching Hospital and Babylon Specialized Medical Rehabilitation Center (October 2024–July 2025). Anxiety severity was quantified using a modified Hamilton rating scale for anxiety (HAM-A) as mild (70–116.66), moderate (116.67–163.33), and severe (163.34–210). Sociodemographic (income, education, sex, and age) and clinical data (chronic illness and smoking status) were collected through structured interviews. The relationship between variables was examined using multivariate logistic regression and chi-square tests to identify predictors of severe anxiety. Results: Patients aged >65 years also had disproportionately high rates of severe anxiety (32.4%) compared to their younger counterparts (15.6%), as indicated by a statistically significant chi-square analysis (χ2=8.12, P=0.043). Financial instability was also a cause of higher anxiety, with 37.5% of patients who had “insufficient” income reporting severe anxiety versus only 15.4% of patients who had “sufficient” income (P=0.012). Clinically, patients with chronic comorbidities were 3.2 times more likely to experience severe anxiety (odds ratio [OR]=3.21, 95% CI, 1.45%, 7.12%, P=0.004), indicating the comorbidity of physical and psychological distress. The level of education was also significant: 28.6% of illiterates experienced severe anxiety compared to 13.6% of those with diploma and above levels (P=0.041). Discussion: The high prevalence of moderate-to-severe anxiety (87.2%) is consistent with global trends and highlights the need for universal mental health screening in post-stroke patients. Independent predictors, such as advanced age, low income, and a high burden of chronic disease, identify vulnerable subgroups that require targeted interventions. The majority of sample post-ischemic stroke patients experienced moderate levels of anxiety, about a quarter of the sample had severe anxiety, and about half of the sample had mild anxiety.