Effect of calcipotriol plus betamethasone dipropionate gel phonophoresis on psoriasis: a single-blind randomized controlled trial Ereny S Wahba Bulletin of Faculty of Physical Therapy 2019 24(2):57-65 Background Psoriasis is a common, immune-mediated, inflammatory disease that can affect all aspects of a person’s life including esthetic appearance, relationships with others, and psychological, social, and physical functioning. Objective This study was conducted to investigate the therapeutic benefits of calcipotriol plus betamethasone dipropionate gel (Dovobet gel) phonophoresis in the treatment of plaque psoriasis. Patients and methods Forty patients with a moderate degree of psoriasis (localized psoriasis) were included, and their age ranged from 25 to 45 years. Patients were randomly assigned into two groups: the study group underwent calcipotriol plus betamethasone dipropionate gel phonophoresis and the control group underwent calcipotriol plus betamethasone dipropionate gel. All treatment interventions were applied at a frequency of three sessions per week for 8 weeks. Outcome measures were performed through ultrasound imaging system that was used to measure the thickness of the skin. The assessment was done before treatment and after 8 weeks of the treatment. Results There was a significant decrease in the skin thickness after treatment in the study group compared with that of control group (P<0.0001). Conclusion Calcipotriol plus betamethasone diproprionate phonophoresis is a useful therapeutic procedure in the treatment of plaque psoriasis.

Caffeine phonophoresis versus shock wave therapy for adult women with cellulite: a randomized controlled trial Haidy N Ashem, Amira H Draz, Amr A Abdel-Aziem Bulletin of Faculty of Physical Therapy 2019 24(2):66-71 Background Cellulite is a widespread problem involving women’s buttocks and thighs (85% of postadolescent women). It is characterized by an irregular, dimpled skin surface with thinning of the epidermis/dermis and presence of nodular clusters of fat cells. Caffeine has anticellulite effect owing to its lipolytic activity in fatty cells. Moreover, shock wave therapy treats cellulite through improvement of cell permeability. Objective To compare between the effects of caffeine phonophoresis and shock wave therapy in the treatment of women with cellulite. Participants and methods A total of 41 women with bilateral cellulite grade 2 and 3 at their thighs (ages 30–45 years) were randomly assigned into two groups. The caffeine phonophoresis group received caffeine 5% gel phonophoresis with an intensity of 0.2 W/cm2 at a rate of 1 min/cm2, three times/week. The shock wave group received shock wave therapy for two times/week. The treatments were conducted to a randomly selected side (the contralateral side serving as an untreated control). The cellulite grade and skin fold thickness were measured before and after 4 weeks of intervention. Results There was a significant decrease in the cellulite grade and skin fold thickness of the treated side of both groups (P=0.001). There was no significant difference between the pretreatment values of both groups (P=0.724 and 0.341, respectively), and no significant difference between the posttreatment values of cellulite grade and skin fold thickness of both groups (P=0.149 and 0.268, respectively). Conclusion Caffeine phonophoresis and shock wave therapy were equally effective in improving the cellulite grade and skin fold thickness in adult women with cellulite.

Effect of reproductive hormones variation during menstrual cycle on hip abductor and adductor muscles performance in college students Abeer M ElDeeb, Doaa M Osman, Hanaa K Atta, Hamada A Hamada Bulletin of Faculty of Physical Therapy 2019 24(2):72-78 Background The hip abductors and adductors play an important role in the stability of the hip and knee joints and knee injury risk. Menstrual cycle is associated with hormones fluctuations that may affect functions of muscles and ligaments and increase the knee risk injury. However, their effect on the abductors and adductors performance is still unknown, which may be a step in developing conditioning programs to reduce injury risk. Objectives This study aimed to examine the effect of hormones variation during menstrual cycle on abductor and adductor muscles performance in sedentary college students. Patients and methods Twenty-four college students completed the study protocol. Their age and BMI ranged from 19 to 25 years and 25–29.9 kg/m2, respectively. Levels of estradiol, progesterone, luteinizing hormone, and follicle-stimulating hormone were measured. Biodex system 3-isokinetic dynamometer was used to measure isokinetic parameters of hip abductor and adductor muscles including peak torque, maximum work, total work, average power, work repetition number, work fatigue percentage, angle of peak torque, acceleration time, and deceleration time. Measurements were taken during early follicular (1–3 days) and mid-luteal phases (21–23 days), which were detected using basal body temperature method. Results There were significant increases in estradiol (P=0.0001), progesterone (P=0.002), peak torque of hip abductors (P=0.03) and adductors (P=0.04), maximum work of hip abductors (P=0.01), total work of hip abductors (P=0.01) and adductors (P=0.02), and average power of hip abductors (P=0.0.01) and adductors (P=0.02) during the mid-luteal phase compared with the early follicular phase. Conclusions Abductor and adductor muscles strength changes with the surging levels of estradiol and progesterone during normal menstrual cycle that need to be considered in strengthening exercises for sedentary college students to avoid injury risk.

Immediate effect of maximal treadmill walking on muscle fatigue and postural stability in children with cerebral palsy Walaa A. Abd El-Nabie, Maha A Attia Bulletin of Faculty of Physical Therapy 2019 24(2):79-84 Aim Postural instability and muscle fatigue are from elementary causes of deteriorations in children with cerebral palsy (CP). The aim of this study was to investigate the immediate effect of maximal treadmill walking on muscle fatigue and postural stability in children with hemiplegic CP. Patients and methods Thirty (17 boys and 13 girls) children with hemiplegic CP of both sexes, aged from 5 to 11 years, participated in this study. Muscle fatigue and postural stability were assessed for every child by using isokinetic dynamometer and pediatric reaching test, respectively, before and after maximal treadmill walking at two separated sessions. Results The results showed that there were no significant differences in fatigue index (P=0.33 and 0.1), peak torque of quadriceps and hamstring muscles (P=0.52 and 0.14), and anterior and lateral reaching tests of postural stability (P=0.46 and 0.63) before and after maximal treadmill walking. Conclusion Maximal treadmill walking does not cause muscle fatigue or postural instability in children with hemiplegic CP.

Impact of core stability education on postural control in children with spastic cerebral palsy Mostafa S Ali Bulletin of Faculty of Physical Therapy 2019 24(2):85-89 Background Postural control includes controlling the body’s position in space to achieve stability and orientation. Core stability education is applied to teach children to improve balance and postural control. Objective The objective of this study was to detect the impact of core stability education on postural control in children with spastic cerebral palsy (CP). Patients and methods Thirty spastic CP children (6–8 years) received intervention in the outpatient clinic of Faculty of Physical Therapy, Cairo University. Intervention The participants were randomly divided into a control group and a study group; the control group received selective therapeutic exercises, while the study group received the same selective program in addition to core stability exercises three times/week for 60 min for 12 weeks. Main outcome measures Dynamic balance was assessed by Biodex Balance System before and after treatment (12 weeks). Results There was a significant improvement of all stability indices (anteroposterior, mediolateral, and overall) in each group. There was more improvement in the study group when comparing post-treatment values of both groups (P<0.05). Conclusion According to the results of the current study, core stability program is highly recommended to be included in the treatment program of spastic CP children to improve balance.

Influence of sensory integration training on postural instability in elderly with parkinsonian disease following stereotactic surgery Ahmed M Elshinnawy, Amir N Wadee, Ahmed M Tawfick Bulletin of Faculty of Physical Therapy 2019 24(2):90-98 Background Impaired posture is strongly associated with function particularly in patients with parkinsonian disease (PD). Objective To detect the effect of sensory integration training on postural instability in elderly PD following stereotactic surgery. Patients and methods A total of 27 patients with idiopathic PD were assessed before and after 12 weeks by the postural stability test. They were randomly assigned into three groups: group I (sensory integration training), group II (stereotactic surgery), and group III (sensory integration training after 10 days postoperatively). Results There was significant improvement in group III more than in groups I and II. The percent of improvement of group III was higher concerning the overall stability index (48.86%, t=7.088 and P=0.0001(, anterior/posterior index (74.61%, t=21.240 and P=0.0001), and medial/lateral index (55.81%, t=14.014 and P=0.0001). Group III was superior to groups I and II (P=0.026 and 0.001, 0.040 and 0.0001, and 0.049 and 0.0001). Conclusion Sensory integration training improved postural stability in elderly with PD following stereotactic surgery.

Effect of walking aids and foot orthoses on energy expenditure in children with cerebral palsy: a systematic review Walaa Abd El-Hakiem Abd El-Nabie, Heba G Abd El Aziz, Shorouk Elshennawy Bulletin of Faculty of Physical Therapy 2019 24(2):99-112 Background Walking aids and ankle–foot orthoses (AFOs) are designed to address gait problems. These devices are common among children with cerebral palsy (CP), as those children’s ability to ambulate is a big concern for their parents, and its improvement is considered primary focus of therapeutic modalities addressing motor disorders of this population. However, empirical support for walking aids and AFO is limited. The aim of this review was to assess the quality of research on the effect of walking aids and AFO on energy expenditure in children with CP. Materials and methods Four electronic databases using predefined terms were searched by two independent reviewers. All study designs except case reports were included. Nineteen studies involving 509 participants met inclusion criteria and were involved in this review. Results Heterogeneity was observed across included studies in measurement, implementation, and study rigor. Conclusion There is a need for high-quality studies to draw a clear conclusion on the effect of walking aids and AFO on energy expenditure in children with CP; the typical flaws of existing studies included weak experimental designs, insubstantial treatment outcomes, and high risk of bias.

The quality of physiotherapy care: the development and application of quality indicators using scientific evidence and routinely collected data embedded in the process of clinical reasoning Rob A.B Oostendorp, J.W. Hans Elvers, Emiel van Trijffel Bulletin of Faculty of Physical Therapy 2019 24(2):113-120 Quality improvement has become a central tenet of physiotherapy care. Quality indicators (QIs) as measurable elements of care have been used over the past 25 years to analyze and evaluate the quality of physiotherapy care. The aim of this article is to describe the state of the art regarding the development and application of QIs in physiotherapy primary care when embedded in a clinical reasoning process. In contrast to international clinical practice guidelines, Dutch physiotherapy clinical practice guidelines are generally based on the clinical reasoning process in combination with best available evidence. Information required to develop QIs is preferably derived by combining available systematic review-based scientific evidence, guideline-based recommendations, and routinely collected data with clinical evidence, professional expertise and standards, and patient perspectives. A set of QIs (n=28) in patients with whiplash-associated disorders was developed and embedded per step of the clinical reasoning process in physiotherapy care: (a) administration (n=2); (b) history taking (n=7); (c) objectives of examination (n=1); (d) clinical examination (n=4); (e) analysis and conclusion (n=2); (f) treatment plan (n=3); (g) treatment (n=2); (h) evaluation (n=5); and (i) discharge (n=2). The use of QIs represents a useful tool for measuring the (improvement of) quality of physiotherapy primary care, as many evidentiary gaps still exist in terms of diagnostics, prognostics, and treatment, and concerning patient-related outcome measurements in different patient groups such as patients with musculoskeletal pain. The recommended set of QIs embedded in the clinical reasoning process for patients with whiplash-associated disorders can be used as a starting point for the development of a general set of QIs that measure the (improvement of) quality of primary care physiotherapy.