A Framework for National Rehabilitation Policy and Strategies in Iran: A Scoping Review of Experiences in Other Countries.

BACKGROUND: The main objective of this study was to review the goals and programs of rehabilitative care in different countries to achieve a framework for a national operational plan for expanding rehabilitation services in Iran. METHODS: In this qualitative study (scoping review), national rehabilitation documents were reviewed in a selected list of countries. We searched several databases including Web of Science, PubMed, Scopus, and Google Scholar and main website such as WHO. Then, the review results were presented to a panel of experts to receive their feedback and opinion for a framework of national rehabilitation policy and strategies in Iran. RESULTS: In the preliminary phase, 1775 documents were found and 17 documents were selected from Asia, Europe, three islands near Australia, America, and Australia continents. National policies and programs regarding rehabilitation could be categorized in three fields: 1) Removing the barriers to access rehabilitative health services, 2) strengthening and improving rehabilitation, relevant appropriate technologies, Supportive Services, and Community Based Rehabilitation, and 3) Collecting international data on social support and improving the quality of research and services related to rehabilitation. CONCLUSION: To achieve a successful national rehabilitation framework in any country, it is required to strengthen information and research database, implement annual monitoring of policymaking, assess the next year rehabilitation needs of society, finding causes of disabilities for effective planning.

Sensitivity of high-resolution ultrasonography in clinically diagnosed carpal tunnel syndrome patients with hand pain and normal nerve conduction studies.

BACKGROUND: Suspecting carpal tunnel syndrome (CTS) in patients with hand pain is usual. Considering the variable rate of false-negative results in nerve conduction study (NCS), as a frequent reference confirmatory standard test, we aimed to evaluate the diagnostic accuracy of neuromuscular ultrasound in patients with clinical evidence of CTS and normal NCS. METHODS: It was a diagnostic accuracy study conducted in the outpatient clinic of Rofaydeh Hospital, Tehran, Iran, between July 2012 and December 2016; it recruited clinically diagnosed CTS patients and a control group. All participants underwent comprehensive clinical examination, NCS, and high-resolution ultrasonography of the median nerve. RESULTS: Two hundred and fifty patients with clinical evidence of CTS met the inclusion criteria, of whom 103 (27.1%) had normal NCS and underwent an ultrasound examination. A cutoff point of 9.4 mm2 (mean + 2 standard deviation) for median nerve cross-sectional area at the carpal tunnel inlet from the control group was set to detect 73% abnormality in the case group. CONCLUSION: Ultrasonography had a sensitivity rate of 73% in patients with clinical CTS and negative NCS, increasing the overall diagnostic sensitivity for clinically suspected CTS in the electrodiagnostic lab setting to 92%. The study highlights the complementary role of ultraso-nography in diagnosing CTS in conjunction with NCS.

Effects of adult day care services on disability in older persons: Evaluation of a designed service package in Iran.

OBJECTIVE: To assess the effects of a rehabilitation service package designed by the State Welfare Organization of Iran for adult day care centres on the disability of older clients. METHODS: A case-control study, with 46 older participants in the case group and 46 participants, matched for level of disability, in a control group. The World Health Organization Disability Assessment Schedule 2 was used to collect data at 4 time-points: baseline and 2, 4, and 6 months later. Data were analysed using repeated-measures analysis of variation. RESULTS: The rehabilitation service package had significant effects on the disability scores of older users of day care services. The disability scores significantly changed within the subjects (p = 0.010) and between the 2 groups (p < 0.001). Within-subjects effects in all 6 domains ("understanding and communication" (p = 0.002), "getting around" (p = 0.046), "self-care" (p < 0.001), "getting along with people" (p < 0.001), "life activity" (p < 0.001) and "participation" (p < 0.001)) and between-subjects effects, in all except the "self-care" domain, showed significant differences during the 6-month study period (p = 0.003, p < 0.001, p <0.001, p < 0.001, and p < 0.001, respectively). CONCLUSION: The adult day care service package may have a positive role in decreasing measures of disability among older persons over a 6-month period.

The pattern of muscle involvement in ulnar neuropathy at the elbow.

OBJECTIVE: To determine the pattern of muscle involvement in patients with ulnar neuropathy at the elbow. MATERIALS AND METHODS: This study evaluated all patients referred for upper limb electrodiagnostic study (EDX) during 2007-2011 and included. patients with clinical signs and symptoms of ulnar neuropathy at the elbow. All patients had nerve conduction studies (NCS) for ulnar neuropathy. Needle electromyography (EMG) of four ulnar innervated muscles, flexor carpi ulnaris (FCU), flexor digitrom profoundus (FDP), first dorsal interosseous (FDI) and abductor digiti minimi (ADM)) was evaluated. RESULTS: During the study period 34 (23 males and 11 females) patients were diagnosed with ulnar neuropathy at the elbow and three of them had bilateral involvement. Muscle involvement by EMG was as follows: FDI: 91.9%, ADM: 91.3%, FCU: 64.9% and FDP: 56.8%. CONCLUSION: In this study, EMG abnormalities of nerve damage were presented more commonly in the FCU muscle than in the FDP in patients with ulnar nerve lesion at the elbow.