Level 3.

Background High toll of traffic-related injuries, climate change, natural disasters, population aging, as well as chronic diseases have all made considerable demands on receiving physiotherapy services in Iran. Nevertheless, there is an assortment of complications facing utilization of such services, particularly poor insurance coverage. Therefore, the present study investigated and identified gaps in insurance coverage in order to inform future policy reforms and the design of a more comprehensive and universal benefits package for physiotherapy services in Iran. Methods This project was carried out in Iran, using a mix-methods (viz. qualitative-quantitative) approach. Within the first phase, a qualitative study was completed to find policy recommendations. Such recommendations were then prioritized through the Analytical Hierarchy Process (AHP), in the second phase, based on effectiveness, acceptability, cost, fairness, feasibility, and time. Results Within the first phase, a total number of 30 semi-structured interviews with health policy-makers, health insurers, faculty members, rehabilitation experts, and physiotherapists were completed. Several policy recommendations were also proposed by the study participants. Following the second phase, prioritized recommendations were provided to promote stewardship (e.g., informing policy-makers about physiotherapy services), collection of funds (e.g., placing value-added taxes on luxury goods and services), pooling of funds (e.g., moving allocated resources towards insurance (viz. third-party) mechanism), purchasing (e.g., using strategic purchasing), and benefit package (e.g., considering preventive interventions) as the main components of insurance coverage. Conclusion The study findings provided a favorable ground to improve insurance coverage for physiotherapy services in Iran. As well, decision- and policy-makers can place these recommendations on the agenda in the health sector to protect population health status, especially that of groups with disabilities.

Purpose:The goal of this study was to compare the cheese-wiring effects of three sutures with different coefficients of friction.Materials and Methods:Sixteen human cadaveric shoulders were dissected to expose the distal supraspinatus and infraspinatus muscle tendons. Three sutures were stitched through the tendons: #2 Orthocord™ suture (reference #223114, DePuy Mitek, Inc., Raynham, MA), #2 ETHIBOND* EXCEL Suture, and #2 FiberWire® suture (FiberWire®, Arthrex, Naples, FL). The sutures were pulled by cyclic axial forces from 10 to 70 N at 1 Hz for 1000 cycles through a MTS machine. The cut-through distance on the tendon was measured with a digital caliper.Results:The cut-through distance in the supraspinatus tendons (mean ± standard deviation, n = 12) were 2.9 ± 0.6 mm for #2 Orthocord™ suture, 3.2 ± 1.2 mm for #2 ETHIBOND* suture, and 4.2 ± 1.7 mm for #2 FiberWire® suture. The differences were statistically significant analyzing with analysis of variance (P = 0.047) and two-tailed Student's t-test, which showed significance between Orthocord™ and FiberWire® sutures (P = 0.026), but not significant between Orthocord™ and ETHIBOND* sutures (P = 0.607) or between ETHIBOND* and FiberWire® sutures (P = 0.103).Conclusion:The cheese-wiring effect is less in the Orthocord™ suture than in the FiberWire® suture in human cadaveric supraspinatus tendons.Clinical Relevance:Identification of sutures that cause high levels of tendon cheese-wiring after rotator cuff repair can lead to better suture selection.

Objectives: Pregnancy is one of the pleasant periods of a woman’s life that turns into a bitter experience by common complications such as low back pain (LBP). Due to prevailing climatic conditions in Iran and the harmful social norms concerning Iranian women, the present study aimed to investigate the prevalence of pregnancy-related LBP and its influencing factors during different months of pregnancy. Materials and Methods: This descriptive cross-sectional study was conducted in 2019 on 550 pregnant women for LBP who were eligible based on the inclusion criteria. The research instruments were a demographic questionnaire, a LBP examination, and the visual analog scale (VAS). The obtained data were analyzed using the chi-square test, the independent t test, and multiple logistic regression in SPSS 20, and a P<0.05 was considered statistically significant. Results: The prevalence of LBP was 67.27%, and the most important factors influencing pregnancy-related LBP were maternal age (OR=950, P<0.008), gestational age (OR=1.023, P=0.015), body mass index (OR=802, P=0.045), duration of sitting (OR=1.812, P=0.036), and the duration of standing (OR=1.625, P=0.042). Conclusions: Overall, there was a high prevalence of pregnancy-related LBP in primiparous women in the present study and its predisposing risk factors included advanced maternal age, obesity, and low level of ability to sit and stand for a long time.