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1.  Migration of a Broken Steinman Pin into the Posterior Compartment of the Leg 12 Years after Total Hip Arthroplasty 
This report is on a migration of a Steinman pin into the posterior compartment of the calf. It was used to fix a greater trochanteric osteotomy in a total hip arthroplasty. The puzzling note is how this metal piece passed through the anterolateral compartment of the thigh to the posterior compartment of the calf. According to our literature review, migration of fixation pins through the knee joint is an extremely rare occurrence and could be missed by an inattentive physician.
PMCID: PMC4151395  PMID: 25207282
Total hip arthroplasty; Pin migration; Trochanter osteotomy; Implant complication; Steinman pin
2.  Clinical outcome of en-block resection and reconstruction with nonvascularized fibular autograft for the treatment of giant cell tumor of distal radius 
Background:
Although giant cell tumor (GCT) is considered to be a primary benign bone tumor, its aggressive behavior makes its diagnosis and treatment, difficult and challenging. This is especially true in distal radius where GCT appears to be more aggressive and difficult to control locally. We report our clinical outcome of en-block resection and reconstruction with non-vascularized fibular autograft in 15 patients with distal radius GCT.
Materials and Methods:
We retrospectively reviewed 15 patients with GCT (Grade 2 and 3) of distal radius who were treated with en-block resection and non-vascularized fibular autograft. Five of 15 were recurrent GCT treated initially with extended curettage; local adjuvant therapy and filling the cavity with cement or bone graft. We followed the patients for mean 7.2 years post operation (range: 4-11 years). Patients were evaluated post operation with clinical examination, plain radiography of distal radius and chest X-ray and/or computed tomography scan. Furthermore pain, function, range of motion and grip strength of the affected limb were evaluated and mMayo wrist score was assessed.
Results:
A total of 11 patients were women and 4 were men. Mean age of patients was 29 years (range: 19-48). We had no lung metastasis and bony recurrence occurred in one patient (6.6%). Nearly 53.3% of patients had excellent or good functional wrist score, 80% of the patients were free of pain or had only occasional pain and 80% of patients returned to work. Mean range of motion of the wrist was 77° of flexion-extension and mean grip strength was 70% of the normal hand.
Conclusion:
En-block resection of distal radius GCT and reconstruction with non-vascularized fibular autograft is an effective technique for treatment in local control of the tumor and preserving function of the limb.
PMCID: PMC3999596  PMID: 24778664
Autograft; distal radius; giant cell tumor; outcome; reconstruction; fibular graft
3.  Massive Emphysema and Pneumothorax Following Shoulder Arthroscopy under General Anaesthesia: A Case Report 
The patient was a 61-year-old female with massive rotator cuff tear who had no history of smoking, COPD, asthma, or other pulmonary diseases. Four hours following shoulder arthroscopy, the patient developed progressive dyspnea, which was diagnosed as pneumothorax with subcutaneous emphysema extending to the neck and face. Chest tube was inserted promptly. The patient was discharged with a good condition after 7 days. Follow up of the patient for the next 3 months was uneventful.
PMCID: PMC5736897
Emphysema; General anesthesia; Pneumothorax; Shoulder arthroscopy
5.  Evaluation of Normal Ranges of Wrist Radiologic Indexes in Mashhad Population 
Hand and wrist radiographic indexes such as radial inclination, ulnar variance, carpal height ratio, and radial tilt play an important role in the diagnosis and management of medical disorders, so they should be modified regarding the population and race difference. This study aims to compare the normal radiologic wrist indexes in Mashhad population with other existing databases and define some of the factors that may influence the normal radiographic indexes.
A total of 100 healthy participants were enrolled in this prospective cross-sectional study. After performing PA and lateral wrist radiographs, all radiological indexes including the wrist height; 1st and 3rd metacarpal length; ulnar variance; radial tilt and radial inclination; radiolunate, capitolunate, and scapholunate angle; capitate and scaphoid length; lunate and wrist width; and lunate diameter were measured.
Significant differences were found between the two genders in the 1st and 3rd metacarpal length (P<0.001 and P<0.001 respectively), wrist height (P<0.001), radial tilt (P=0.027), radiolunate angle (P=0.001), capitate and scaphoid length (P<0.001 and P<0.001 respectively), lunate and wrist width (P<0.001 and P<0.001 respectively), lunate length (P=0.003), and lunate diameter (P<0.001). A significant linear correlation was found between ulnar variance (P=0.003), scapholunate angle (P=0.016), and wrist ratio (P=0.011) with age.
According to our findings, using population specific wrist and hand indexes is recommended to diagnose and follow up upper extremities conditions.
PMCID: PMC5736896
Normal ranges; Radiologic indexes; Wrist
6.  Single Cut Distal Femoral Varus Osteotomy (SCFO): A Preliminary Study 
Background:
Genu valgum usually originates from a deformity of distal femur that is often corrected by distal femoral varus osteotomy. The osteotomy includes both components of angulationcorrection and translation because the site of osteotomy is not commonly at the apex of deformity. Improvement of patellar tracking not only depends on valgus correction, but also it may be partially due to centralization of the trochlear groove under the femoral anatomical axis (FAA).
We asked whether we could accurately correct the deformities based on our preoperative goals for the correction of the mechanical axis and centralization of the trochlear groove under the FAA by using a single bone cut.
This study describes a new lateral single cut distal femoral osteotomy (SCFO) that enables concurrent correction of angulation and translation.
Methods:
This study was done on 12 young adult patients with femoral juxta-articular genu valgum deformity using SCFO. The average age at operation was 21 years (range: 16-25). SCFO is a type of closing-opening distal femoral osteotomy that corrects the valgus deformity of the distal femur while the translation of the distal fragment is done using one oblique cut. It centralizes the trochlear groove under the FAA. We compared the pre and postoperative radiographic and clinical variables including mechanical tibiofemoral angle, knee range of motion (ROM), International knee documentation committee (IKDC) score and the time to union. Mean follow-up of the patients was 24 months.
Results:
The average mechanical tibiofemoral angle improved from 16 degrees (10-23) to 1 degrees (-2 to +2). IKDC subjective score slightly improved from preoperative (65) to 2-year follow-up (71). Centralization of the trochlea was achieved in all patients.
Conclusion:
SCFO can be a reasonable alternative for correction of the distal femur genu valgum deformity. It can centralize the patellar groove under the FAA with satisfactory clinical outcomes.
PMCID: PMC5712399
Femoral osteotomy; Genu valgum; SCFO; Single cut; Valgus
8.  Short Form-McGill Pain Questionnaire-2 (SF-MPQ-2): A Cross-Cultural Adaptation and Validation Study of the Persian Version in Patients with Knee Osteoarthritis 
Background:
We aimed to develop and validate the Persian version of Short Form McGill Pain Questionnaire-2 (SF-MPQ-2) in patients with knee osteoarthritis.
Methods:
Translation and back translation was performed using Beaton's guideline. After a consensus has achieved on the Persian version of SF-MPQ-2, it was administered to 30 patients with knee osteoarthritis in a pilot study. Then, we enrolled 100 patients with knee osteoarthritis to fill the final SF-MPQ-2 as well as SF-36 and WOMAC questionnaires. Forty-three patients returned 3 days after the initial visit to fill the Persian SF-MPQ-2 for the second time. Construct validity was tested by Pearson's correlation coefficient between subscales of SF-MPQ-2 and subscales of SF-36 and WOMAC. Internal consistency for total and subscales was calculated by Cronbach's alpha and reliability between test retest was performed using Intraclass correlation coefficient (ICC).
Results:
ICC for subscales of SF-MPQ-2 ranged from 0.73 to 0.90. The ICC for total SF-MPQ-2 was 0.90. Cronbach's alpha for subscales was 0.65-0.74 at the first visit and 0.58-0.81 at the second visit. Cronbach's alpha for the total questionnaire was 0.88 and 0.91 at the first and second visit, respectively. Pearson's correlation coefficient was highly significant when comparing subscales specifically with WOMAC (r=-0.47 to -0.61; P<0.001). Interscale correlation between subscales of SF-MPQ-2 was significant as well (r: 0.43-0.88, P<0.001).
Conclusions:
Persian SF-MPQ-2 showed excellent reliability and good to excellent internal consistency throughout the questionnaire. It is a valid and reliable instrument for measuring the pain intensity and applicable in osteoarthritic pain assessment.
PMCID: PMC4322125  PMID: 25692169
Persian; Psychometric; Reliability; Short from McGill pain questionnaire; Validity
9.  Psychometric Properties of the Persian Version of the Patient Rated Wris t Evaluation 
Background:
The patient-rated wrist evaluation (PRWE) score is one of the most common clinical instruments used as an outcome measurement tool for distal radius fractures and other upper extremity conditions. The purpose of this study was to translate the PRWE into its Persian version and to evaluate its validity and reliability in patients with upper extremity conditions.
Methods:
One hundred and fourthly one adult patients with upper extremity conditions participated in this ethical board approved study from August 2015 to May 2016. After translating the original version of the PRWE into Persian, all patients filled out the PRWE in addition to the VAS (Visual analogue scale) and DASH questionnaires. For evaluating reliability, after three days the researchers called back some of the patients who did not receive treatment or any changes in symptoms and asked them to complete the PRWE retest (104 patients).
Results:
Cronbach’s alpha was calculated as high as 0.934, implying very reliable internal consistency. After each item deletion, the Cronbach’s alpha was still constant (range: 0.926 to 0.936). Intraclass correlation coefficient was 0.952 and this showed excellent test-retest reliability. The correlation coefficient between the PRWE and DASH scores was strong. Multivariable analysis showed an association between the PRWE and years educated.
Conclusion:
Our study has shown that the Persian version of the PRWE is valid and reliable for patients with upper extremity conditions.
PMCID: PMC5592366  PMID: 28913382
Hand Surgery; Iran; Persian; PRWE; Psychometric properties; Translation; Validation; Wrist
10.  Factors Associated with Pain, Disability and Quality of Life in Patients Suffering from Frozen Shoulder 
Background:
Frozen shoulder is resulting in limb disability and reduction of quality of life but the factors associated with patients’ disability and quality of life is not clear. To assess pain, disability, the quality of life and factors associated with them in patients suffering from frozen shoulder.
Methods:
We enrolled 120 patients (37 men and 83 women) with phase-II idiopathic frozen shoulder in our cross-sectional study. Demographic data were collected and shoulder range of motion was measured in four different directions (elevation, abduction, external and internal rotation) in both upper limbs. Patients were asked to fill out Visual Analog Scale for pain (VAS) and, Short-Form Health Survey questionnaire (SF-36) as well as Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires. We asked the patients to fill out the Hamilton anxiety and depression questionnaires.
Results:
The mean of VAS pain, DASH, PCS, and MCS scores were 69(18), 53(17), 35(8.0), and 42(10) respectively. All the domains of SF36 questionnaires where below the normal population except physical function. VAS pain score was correlated to Hamilton depression scores in both bivariate and mulivarilable analysis. DASH score were correlated to sex, age, ROM, and both Hamilton anxiety and depression scores; However, DASH score only impact with Hamilton anxiety and ROM independently. PCS is correlated to age and MCS to Hamilton depression.
Conclusion:
Patient with frozen shoulder are more suffering from pain and disability secondary to psychiatric parameters such as depression and anxiety than demographic features or even restriction of range of motion.
PMCID: PMC4969371  PMID: 27517070
Adhesive capsulaitis; Disability; Frozen shoulder; Pain; Quality of life; Shoulder
12.  Prognostic Factors Affecting the Results of Modified Thompson Quadricepsplasty for the Treatment of Extension Contracture of the Knee 
Background:
Knee extension contracture is a disabling complication after fractures around the knee. In this study we aimed to study factors influencing the outcomes of quadricepsplasty for the treatment of traumatic knee extension contracture. We hypothesized that there is no factor influencing the final range of knee motion.
Methods:
In this retrospective study, we included 64 patients who underwent modified Thompson quadricepsplasty between 2008 to 2011 with a mean follow-up time of 36 months.
Results:
The mean change in flexion was 66 degrees. Using Judet criteria, results were excellent in 41 patients (64%), good in 15 (23%), fair in 4 (6%) and poor in 4 (6%). Preoperative arc of flexion, duration of extension contracture, number of previous surgeries on the limb, and BMI of the patients were independently influencing the final flexion.
Conclusion:
Modified Thompson quadricepsplasty is associated with high number of excellent and good results especially when it is performed earlier in more severe contractures.
Preoperative arc of flexion, interval between trauma surgery and quadricepsplasty, the number of prior surgeries, and BMI influence the outcomes of quadricepsplasty.
PMCID: PMC5410742
Knee; Judet; Modified thompson; Quadricepsplasty
14.  Validity and Reliability of the Persian Version of Shortened Disabilities of the Arm, Shoulder and Hand Questionnaire (Quick-DASH) 
Background:
The aim was to assess the validity and reliability of the Persian version of shortened disabilities of the arm, shoulder, and hand (Quick-DASH) questionnaire in patients with upper extremity conditions.
Methods:
We administered the Persian version of Quick-DASH to 202 patients with upper extremity conditions, of which 71 patients randomly returned after 3 days to respond to the questionnaire for the 2nd time. In order to test the construct validity of the questionnaire, patients responded to the Michigan Hand Outcome Questionnaire (MHOQ) and Short Form 36 Health Survey (SF-36) as well. Internal consistency was tested using the Cronbach's alpha, and test-retest reliability was measured using intra-class correlation coefficient (ICC).
Results:
Cronbach's alpha was 0.90. ICC was 0.89. Convergent validity was confirmed, as the Spearman correlation between the Quick-DASH and MHOQ was 0.67 and ranged from 0.24 to 0.56 between the subscales of the SF-36 and Quick-DASH.
Conclusions:
Observation of excellent internal consistency, good to excellent test-retest reliability, and moderate to strong construct validity confirms the validity and reliability of the Persian version of Quick-DASH for evaluating the magnitude and level of disability in upper extremity conditions.
doi:10.4103/2008-7802.160336
PMCID: PMC4521304  PMID: 26288703
Persian; psychometric; Quick-disabilities of the arm; shoulder and hand; reliability; validity
15.  Radial Tunnel Syndrome, Diagnostic and Treatment Dilemma 
Radial tunnel syndrome is a disease which we should consider it in elbow and forearm pains. It is diagnosed with lateral elbow and dorsal forearm pain may radiate to the wrist and dorsum of the fingers. The disease is more prevalent in women with the age of 30 to 50 years old. It occurs by intermittent compression on the radial nerve from the radial head to the inferior border of the supinator muscle, without obvious extensor muscle weakness. Compression could happen in five different sites but the arcade of Frose is the most common area that radial nerve is compressed. To diagnosis radial tunnel syndrome, clinical examination is more important than paraclinic tests such as electrodiagnsic test and imaging studies. The exact site of the pain which can more specified by rule of nine test and weakness of the third finger and wrist extension are valuable physical exams to diagnosis. MRI studies my show muscle edema or atrophy along the distribution of the posterior interosseous nerve. Although non-surgical treatments such as rest, NSAIDs, injections and physiotherapy do not believe to have permanent relief, but it is justify undergoing them before surgery. Surgery could diminish pain and symptoms in 67 to 93 percents of patients completely.
PMCID: PMC4507067  PMID: 26213698
Diagnosis; Radial Tunnel Syndrome; Treatment
16.  Chronic Osteomyelitis in the Femoral Midshaft Following Arthroscopic ACL Reconstruction 
A 25 year-old man presented with pain, swelling, and intermittent drainage from distal lateral aspect of his left knee three months after undergoing isolated ACL reconstruction with arthroscopic hamstring autograft and endobottom technique. His surgeon at that time tried to eliminate the pathology through arthroscopic wash out in two attempts. However, the pain, edema, and discharge recurred after a year of being symptom free. The patient underwent imaging assessment and anteroposterior and lateral radiographs demonstrated a sclerotic area beneath the femoral condoyle in femoral tunnel and a fusiform sclerotic area in the lateral aspect of femoral midshaft. Magnetic Resonance Imaging revealed necrotic tissue with bone edema consistent with the sclerotic area in radiographs indicating micro abscesses and osteomyelitis. A diagnosis of femoral chronic osteomyelitis was made and the patient underwent arthroscopic drainage and washout, followed by open surgery for diaphysial femoral osteomyelitis. Rehabilitation was started and after six months the patient returned to his work.
PMCID: PMC4322129  PMID: 25692173
ACL; ACL Reconstruction; Infection; Osteomyelitis
17.  Clinical Outcomes after Arthroscopic Release for Recalcitrant Frozen Shoulder 
Background:
To explain the role of arthroscopic release in intractable frozen shoulders. We used different questionnaires and measuring tools to understand whether arthroscopic release is the superior modality to treat patients with intractable frozen shoulders.
Methods:
Between 2007 and 2013, in a prospective study, we enrolled 80 patients (52 females and 28 males) with recalcitrant frozen shoulder, who underwent arthroscopic release at Ghaem Hospital, a tertiary referral center, in Mashhad, Iran. Before operation, all patients filled out the Disability of Arm, Shoulder and Hand (DASH), Constant, University of California Los Angeles (UCLA), ROWE and Visual Analogue Scale (VAS) for pain questionnaires. We measured the difference in range of motion between both the normal and the frozen shoulders in each patient.
Results:
The average age of the patients was 50.8±7.1 years. In 49 patients, the right shoulder was affected and in the remaining 31 the left side was affected. Before surgery, the patients were suffering from this disease on average for 11.7±10.3 months. The average time to follow-up was 47.2±6.8 months (14 to 60 months). Diabetes mellitus (38%) and history of shoulder trauma (23%) were the most common comorbidities in our patients. We did not find any significant differences between baseline characteristics of diabetics patients with non-diabetics ones. After surgery, the average time to achieve maximum pain improvement and range of motion were 3.6±2.1 and 3.6±2 months, respectively. The VAS score, constant shoulder score, Rowe score, UCLA shoulder score, and DASH score showed significant improvement in shoulder function after surgery, and shoulder range of motion improved in all directions compared to pre-operation range of motion.
Conclusions:
According to our results, arthroscopic release of recalcitrant frozen shoulder is a valuable modality in treating this disease. This method could decrease pain and improve both subjective and objective mid-term outcomes.
PMCID: PMC4225030  PMID: 25386586
Arthroscopic release; Frozen shoulders; Outcome; Recalcitrant
18.  Validity and Cross-Cultural Adaptation of the Persian Version of the Oxford Elbow Score 
Oxford Elbow Score (OES) is a patient-reported questionnaire used to assess outcomes after elbow surgery. The aim of this study was to validate and adapt the OES into Persian language. After forward-backward translation of the OES into Persian, a total number of 92 patients after elbow surgeries completed the Persian OES along with the Persian DASH and SF-36. To assess test-retest reliability, 31 randomly selected patients (34%) completed the Persian OES again after three days while abstaining from all forms of therapeutic regimens. Reliability of the Persian OES was assessed by measuring intraclass correlation coefficient (ICC) for test-retest reliability and Cronbach's alpha for internal consistency. Spearman's correlation coefficient was used to test the construct validity. Cronbach's alpha coefficient was 0.92 showing excellent reliability. Cronbach's alpha for function, pain, and social-psychological subscales was 0.95, 0.86, and 0.85, respectively. Intraclass correlation coefficient (ICC) was 0.85 for the overall questionnaire and 0.90, 0.76, and 0.75 for function, pain, and social-psychological subscales, respectively. Construct validity was confirmed as the Spearman correlation between OES and DASH was 0.80. Persian OES is a valid and reliable patient-reported outcome measure to assess postsurgical elbow status in Persian speaking population.
doi:10.1155/2014/381237
PMCID: PMC4158467  PMID: 25214845
19.  Psychometric Properties of the Persian Version of the Simple Shoulder Test (SST) Questionnaire 
Background:
To validate the Persian version of the simple shoulder test in patients with shoulder joint problems.
Methods:
Following Beaton`s guideline, translation and back translation was conducted. We reached to a consensus on the Persian version of SST. To test the face validity in a pilot study, the Persian SST was administered to 20 individuals with shoulder joint conditions. We enrolled 148 consecutive patients with shoulder problem to fill the Persian SST, shoulder specific measure including Oxford shoulder score (OSS) and two general measures including DASH and SF-36. To measure the test-retest reliability, 42 patients were randomly asked to fill the Persian-SST for the second time after one week. Cronbach’s alpha coefficient was used to demonstrate internal consistency over the 12 items of Persian-SST.
Results:
ICC for the total questionnaire was 0.61 showing good and acceptable test-retest reliability. ICC for individual items ranged from 0.32 to 0.79. The total Cronbach’s alpha was 0.84 showing good internal consistency over the 12 items of the Persian-SST. Validity testing showed strong correlation between SST and OSS and DASH. The correlation with OSS was positive while with DASH scores was negative. The correlation was also good to strong with all physical and most mental subscales of the SF-36. Correlation coefficient was higher with DASH and OSS in compare to SF-36.
Conclusion:
Persian version of SST found to be valid and reliable instrument for shoulder joint pain and function assessment in Iranian population.
PMCID: PMC5100458  PMID: 27847855
Persian; Reliability; Simple shoulder test; Validity
20.  The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in Persian Speaking Patients with Knee Osteoarthritis 
Background:
Osteoarthritis of the knee is the most common chronic joint disease that involves middle aged and elderly persons. There are different clinical instruments to quantify the health status of patients with knee osteoarthritis and one example is the WOMAC score that has been translated and adapted into different languages. The purpose of this study was cultural adaptation, validation and reliability testing of the Persian version of the WOMAC index in Iranians with knee osteoarthritis.
Methods:
We translated the original WOMAC questionnaire into Persian by the forward and backward technique, and then its psychometric study was done on 169 native Persian speaking patients with knee degenerative joint disease. Mean age of patients was 53.9 years. The SF-36 and KOOS were used to assess construct validity.
Results:
Reliability testing resulted in a Cronbach’s alpha of 0.917, showing the internal consistency of the questionnaire to be a reliable tool.
Inter-correlation matrix among different scales of the Persian WOMAC index yielded a highly significant correlation between all subscales including stiffness, pain, and physical function. In terms of validity, Pearson`s correlation coefficient was significant between three domains of the WOMAC with PF, RP, BP, GH, VT, and PCS dimensions of the SF-36 health survey (P<0.005) and KOOS (P<0.0001) .
Conclusions:
The Persian WOMAC index is a valid and reliable patient- reported clinical instrument for knee osteoarthritis.
PMCID: PMC4151432  PMID: 25207315
Iranian version; Knee osteoarthritis; KOOS; Persian; Reliability; Validity; WOMAC
21.  Nonspecific Arm Pain 
Nonspecific activity-related arm pain is characterized by an absence of objective physical findings and symptoms that do not correspond with objective pathophysiology. Arm pain without strict diagnosis is often related to activity, work-related activity in particular, and is often seen in patients with physically demanding work. Psychological factors such as catastrophic thinking, symptoms of depression, and heightened illness concern determine a substantial percentage of the disability associated with puzzling hand and arm pains. Ergonomic modifications can help to control symptoms, but optimal health may require collaborative management incorporating psychosocial and psychological elements of illness.
PMCID: PMC4151410  PMID: 25207288
Arm; Idiopathic arm pain; Nonspecific arm pain; Shoulder
22.  Skeletal Sarcoma on the Site of Retained War Bullet Fragments and a Literature Review on Long-Term Complications of Retained War Shells 
Long-term complications of retained war fragments in the body are not completely known. Also, bullet migration and slow resorption of metals and distortion in some imaging modalities are frequent and well recognized complications but, now we are concerned about neoplastic changes near the retained war fragments.
We reviewed the literature on complication of retained war fragments and report our 2 cases of malignant changes around old retained war fragments in the limbs.
PMCID: PMC4151411  PMID: 25207300
Osteosarcoma; Retained bullet fragment; Sarcoma; War
23.  Cross-Cultural Adaptation, Validation, and Reliability Testing of the Modified Oswestry Disability Questionnaire in Persian Population with Low Back Pain 
Asian Spine Journal  2016;10(2):215-219.
Study Design
Prospective study.
Purpose
We aimed to validate the Persian version of the modified Oswestry disability questionnaire (MODQ) in patients with low back pain.
Overview of Literature
Modified Oswestry low back pain disability questionnaire is a well-known condition-specific outcome measure that helps quantify disability in patients with lumbar syndromes.
Methods
To test the validity in a pilot study, the Persian MODQ was administered to 25 individuals with low back pain. We then enrolled 200 consecutive patients with low back pain to fill the Persian MODQ as well as the short form 36 (SF-36) questionnaire. Convergent validity of the MODQ was tested using the Spearman's correlation coefficient between the MODQ and SF-36 subscales. Intraclass correlation coefficient (ICC) and Cronbach's α coefficient were measured to test the reliability between test and retest and internal consistency of all items, respectively.
Results
ICC for individual items ranged from 0.43 to 0.80 showing good reliability and reproducibility of each individual item. Cronbach's α coefficient was 0.69 showing good internal consistency across all 10 items of the Persian MODQ. Total MODQ score showed moderate to strong correlation with the eight subscales and the two domains of the SF-36. The highest correlation was between the MODQ and the physical functioning subscale of the SF-36 (r=–0.54, p<0.001) and the physical component domain of the SF-36 (r=–0.55, p<0.001) showing that MODQ is measuring what it is supposed to measure in terms of disability and physical function.
Conclusions
Persian version of the MODQ is a valid and reliable tool for the assessment of the disability following low back pain.
doi:10.4184/asj.2016.10.2.215
PMCID: PMC4843055  PMID: 27114759
Persian; Reliability; Modified Oswestry disability questionnaire; Validity; Low back pain
24.  Oxford Shoulder Score: A Cross-Cultural Adaptation and Validation Study of the Persian Version in Iran 
Background:
Oxford shoulder score is a specific 12-item patient-reported tool for evaluation of patients with inflammatory and degenerative disorders of the shoulder. Since its introduction, it has been translated and culturally adapted in some Western and Eastern countries. The aim of this study was to translate the Oxford Shoulder Score (OSS) in Persian and to test its validity and reliability in Persian speaking population in Iran.
Methods:
One hundred patients with degenerative or inflammatory shoulder problem participated in the survey in 2012. All patients completed the Persian version of OSS, Persian DASH and the SF-36 for testing validity. Randomly, 37 patients filled out the Persian OSS again three days after the initial visit to assess the reliability of the questionnaire.
Results:
Cronbach’s alpha coefficient was 0.93. The intraclass correlation coefficient was 0.93. In terms of validity, there was a significant correlation between the Persian OSS and DASH and SF-36 scores (P<0.001).
Conclusion:
The Persian version of the OSS proved to be a valid, reliable, and reproducible tool as demonstrated by high Cronbach’s alpha and Pearson’s correlation coefficients. The Persian transcript of OSS is administrable to Persian speaking patients with shoulder condition and it is understandable by them.
PMCID: PMC4567599  PMID: 26379346
Shoulder pain; Oxford shoulder score; Validation; Reliability; Iran
25.  Mid-term clinical outcome of radial shortening for kienbock disease 
Background:
To evaluate the intermediate-term outcomes of radius shortening as a treatment for Kienbock's disease.
Materials and Methods:
In a historical cohort, 16 skeletally mature patients (9 men and 7 women) with Kienbock disease, who were treated with radial shortening osteotomy between 2002 and 2012, were reviewed in our study. The mean age of our patients was 30 (range 18-43) years old. According to Litchman staging, there were 7 wrists at stage II and 9 wrists at stage III (6 at stage IIIA and 3 at stage IIIB). The data of grip strength, pain (visual analog scale (VAS) score), wrist range of motion (ROM), ulnar variance (according to Palmer method), and the Lichtman stage were gathered before and after surgery. We evaluated overall wrist function using the Mayo Wrist score and disabilities of the arm shoulder and hand (DASH) score before surgery and at the last follow-up.
Results:
The average of follow-up was 7 years (range from 5 to 9 years). Preoperative ulnar variance was −1.3 mm (range from 2.5 to 1) preoperatively. The mean postoperative ulnar variance was 1 mm positive (range from 0.5 to 1.5). The VAS pain score, the mean arc of wrist flexion and extension, and grip strength improved significantly preoperatively compared to after recovery from surgery. The Lichtman stage was unchanged in nine patients, one grade worse in six patients, and one grade better in one patient. The mean DASH and Mayo scores improved significantly postoperatively compare with preoperation. Comparing preoperative positive, neuter, and negative ulnar variance, there was no significant difference in terms of VAS, DASH, and Mayo scores as well as ROM and grip strength.
Conclusion:
Our study shows that radius shortening surgery improves pain and disability regardless of ulnar variance.
PMCID: PMC4400708  PMID: 25983766
Kienbock's disease; mid-term; radial shortening

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