Background: Poor muscle strength, balance, and functional mobility have predicted falls in older adults. Fall prevention guidelines recommend highly challenging balance training modes to decrease falls; however, it is unclear whether certain modes are more effective. The purpose of this study was to determine whether traditional balance training (BT), virtual reality balance training (VR), or combined exercise (MIX) relative to a waitlist control group (CON) would provoke greater improvements in strength, balance, and functional mobility as falls risk factor proxies for falls in older men. Hypothesis: We hypothesized that 8 weeks of MIX will provoke the greatest improvements in falls risk factors, followed by similar improvements after BT and VR, relative to the CON. Study Design: Single-blinded randomized controlled trial NCT02778841 (ClinicalTrials.gov identifier). Level of Evidence: Level 2. Methods: In total, 64 community-dwelling older men (age 71.8 ± 6.09 years) were randomly assigned into BT, VR, MIX, and CON groups and tested at baseline and at the 8-week follow-up. The training groups exercised for 40 minutes, 3 times per week, for 8 weeks. Isokinetic quadriceps and hamstrings strength on the dominant and nondominant legs were primary outcomes measured by the Biodex Isokinetic Dynamometer. Secondary outcomes included 1-legged stance on firm and foam surfaces, tandem stance, the timed-up-and-go, and gait speed. Separate one-way analyses of covariance between groups were conducted for each outcome using baseline scores as covariates. Results: (1) MIX elicited greater improvements in strength, balance, and functional mobility relative to BT, VR, and CON; (2) VR exhibited better balance and functional mobility relative to BT and CON; and (3) BT demonstrated better balance and functional mobility relative to CON. Conclusion: The moderate to large effect sizes in strength and large effect sizes for balance and functional mobility underline that MIX is an effective method to improve falls risk among older adults. Clinical Relevance: This study forms the basis for a larger trial powered for falls.

Surgical management of calcaneal fractures has various complications. In recent years, minimally invasive surgeries have been utilized for a wide range of surgical procedures on different body parts significantly declining complications. This paper compares surgical outcomes of calcaneal fracture management between the open reduction and internal fixation technique (ORIF) and the MIS technique. In this randomized clinical trial forty patients with calcaneus fractures were randomly assigned to two equal groups; ORIF group and MIS group. Patients were followed for 1 year post-operatively. Gissane and Bohler’s angles, AOFAS questionnaire, pain intensity, ability to conduct previous activities and various complications like wound healing complications and irritation with shoe wear were assessed in the final post-operative visit. Eventually data obtained from the two groups were compared. All patients obtained fracture union. Bohler’s and Gissane angles significantly increased and decreased, respectively, after the operation in both groups (p˂0.05), however, no significant difference was found between the two research groups. AOFAS scores and pain intensity was similar in both groups, however, surgical duration in the MIS group was significantly less than the ORIF group (P=0.021). Only one patient from the ORIF group was not able to resume his previous occupation. 12 patients from the ORIF group and five patients from the MIS group experienced irritation from shoe wear (p=0.025). In the ORIF group, 4 patients suffered from wound healing complications, however, none of the patients of the MIS group had wound complications (p=0.035). In conclusion, based on the results, it can be concluded that the MIS technique demonstrated better functional and radiographic outcomes as well as a more favorable complication profile, thus, it is recommended for the management of calcaneus fractures.

Dexmedetomidine (DEX) can prolong duration of anesthesia and shorten onset of sensory and motor block relative to clonidine. This study attempted to compare the efficacy of intravenous DEX and clonidine for hemodynamic changes and block after spinal anesthesia with ropivacaine in lower limb orthopedic surgery. In a double-blind randomized clinical trial, 120 patients undergoing spinal anesthesia in lower limb orthopedic surgery were recruited and divided into three groups using balanced block randomization: DEX group ( n = 40; intravenous DEX 0.2 µg/kg), clonidine group ( n = 40; intravenous clonidine 0.4 µg/kg), and placebo group ( n = 40; intravenous normal saline 10 mL) in which pain scores were assessed using visual analogue scales (at recovery, and 2, 4, 6, and 12 hours after surgery) and time to achieve and onset of sensory and motor block. Statistically significant differences were found in mean arterial pressure among the groups at all times except baseline ( P = 0.001), with a less mean arterial pressure and a prolonged duration of sensory and motor block ( P = 0.001) in the DEX group where pain relieved in patients immediately after surgery and at above mentioned time points ( P = 0.001). Simultaneous administration of intravenous DEX with ropivacaine for spinal anesthesia prolongs the duration of sensory and motor block and relieves postoperative pain, and however, can decrease blood pressure. Although intravenous DEX as an adjuvant can be helpful during spinal anesthesia with ropivacaine, it should be taken with caution owing to a lowering of mean arterial pressure in patients especially in the older adults. This study was approved by Ethical Committee of Arak University of Medical Sciences (No. IR.Arakmu.Rec.1395.450) in March, 2017, and the trial was registered and approved by the Iranian Registry of Clinical Trials (IRCT No. IRCT2017092020258N60) in 2017.

Background and Aim: Ankle injuries are among the most common musculoskeletal injuries in sports, accounting for 10% to 15% of all injuries. Since controlling pain and inflammation in ankle sprains is one of the main goals of treatment, we decided to compare the therapeutic effects of Cheleh daghi Herbal ointment with a common therapeutic gel such as piroxicam. Methods & Materials: This study was performed as a double-blinded clinical trial for 6 months from January 2019 to August 2019. After referral, all patients completed the consent form, and the patientchr('39')s details and study variables were recorded by the evaluator in the research form. To measure joint inflammation, we measured the ankle with a meter tape in the ankle area (cm) and recorded. A goniometer was also used to measure the degree of ankle movements. The symptoms of ankle ecchymosis were also checked by physical examination and observation and recorded in the checklist. Statistical analysis was performed in SPSS V. 18 using statistical tests (the Mann-Whitney U test, the Chi-square, and the independent t-test). Ethical Considerations: The Research Ethics Committee of Arak University of Medical Sciences approved the study (Code: IR.ARAKMU.REC.1396.55) and registered by the Clinical Trial (Code: IRCT2017071720258N53). Results: The Mean±SD age in the control group was 34.2±8.6 years, and in the case group was 35.4±8.9 years. There was no statistically significant difference according to the Mann-Whitney U test (P<0.05). Also, the Mean±SD height in the control group was 1.7±0.12 m and in the case group was 1.72±0.11 m. The results also showed a statistically significant difference between the two groups studied before and after the intervention regarding the mean indicators of pain, swelling, and inflammation around the joints (P<0.05). Conclusion: The results of our study showed that Cheleh daghi Herbal ointment for 3 weeks could be more effective in reducing local pain and inflammation than piroxicam gel treatment.

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