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Evidence-based practice (EBP) is an important factor determining the quality of healthcare. The field of physiotherapy is still limited by indirect access in several countries including the United Arab Emirates (UAE) which creates added pressure to justify the merit in its practitioner’s capabilities. This study explores the behavior, attitudes, awareness and knowledge towards EBP among practicing physiotherapists in the UAE. It also enquires about their perception of the barriers in the implementation of EBP. Using a questionnaire survey of 258 physiotherapists, results show that the awareness of EBP is limited to a few terms including EBP, systematic literature review, and random trials while other terms associated with scientific studies are not known well. The attitude towards EBP was found to be significantly related to the knowledge of EBP (r = 0.208) and the perception of barriers to it (r = 0.156). The EBP behavior was found positively related to its knowledge (r = 0.134) and the perception of barriers (r = 0.216). The physiotherapists prefer to use their own experience and books and research articles to apply EBP but do not consider their peers to be as worthy sources as the others. However, their attitudes towards EBP are largely positive though their perception of barriers grows with better knowledge and understanding of EBP. The barriers in the implementation of EBP are a lack of research knowledge and skills, time, support, and resources which indicate opportunities for the decision-makers to improve the adoption of EBP among these professionals. This study concluded that although physiotherapists in the UAE claim awareness about EBP, their knowledge is limited to a few key terms whereas, attention is needed to improve EBP knowledge and practice.

Low level lasers have been used as an alternative pain relief therapy for muscle and joint pain, since it induces analgesic, anti-inflammatory, and biomodulation effects of the physiological cell functions. The effectiveness of low-level laser therapy in temporomandibular joint dysfunction (TMD) treatment, however, is not well established. Although Surface electromyography (sEMG) has been suggested as a complementary means in TMD diagnosis, the effect of conservative treatments on muscle activity has not yet been thoroughly correlated with (sEMG) findings. To assess the efficacy of low-level laser therapy (LLLT) as compared to occlusive splint therapy (OST) on the TMJ opening index (TOI) and sEMG of masticatory muscles. 112 female subjects suffering from unilateral myogenous TMD, aged 21-30 years-old, were recruited and divided into three groups: LLLT; soft occlusive splint therapy OST and a waitlist group as controls. TMJ opening index (TOI), Visual analogue scale (VAS), surface electromyography (sEMG). A significant reduction was reported in TOI, VAS and the sEMG within the LLLT and OST groups as well as significant decrease in all outcomes between groups in favor of the LLLT group (P< 0.0001). Meanwhile, there was a weak significant difference within the control group probably attributed to the analgesic. Post-hoc pairwise comparisons between groups [control vs occlusive splints, control vs low-level laser and low-level laser vs occlusive splints] revealed significant differences in the VAS and TOI [P = 0.0001; 95% CI: 0.9-2.2, 1.61-4.01, 0.65-1.96].

Russian current (RC), a well-known neuromuscular electrical stimulation operating at 2500 Hz, has demonstrated significant strength improvement over traditional exercises due to its high tolerance and low pain provocation. Despite extensive NMES parameter research, the specific effects of expert modes, particularly ON2 and Rest, remain unexplored. This study investigates the direct effect of these expert modes on quadriceps muscle strength in healthy adults. This is a single-blind, randomization-controlled trial. Forty-eight healthy university students (31 females, 17 males) were assigned in two randomized experimental groups either the ON2 or Rest mode for a 15-minute electrical stimulation session. Quadriceps maximum voluntary isokinetic contraction measurements were taken before and directly after RC application using Biodex Medical Systems 4 pro isokinetic dynamometer. Both RC modes significantly increased the quadriceps muscle torque in healthy adults compared to baseline (p<0.05). Baseline mean torque was 123.28 (SD = 38.8), and post- RC mean torque was 136.67 (SD = 45.76). Deviation from normality was observed at baseline (p = 0.034) and persisted post-RC application (p = 0.017). The Wilcoxon test reported significant increases in quadriceps muscle knee torque for both ON2 and Rest groups (p < 0.001). The lack of ties in ranks and negative Z-values highlight the robustness of the observed effects. The findings of this study align with previous research on NMES and RC supporting the idea that electrical stimulation enhances muscle strength, selecting the appropriate RC expert modes can assist physiotherapist in tailoring rehabilitation program to achieve their specific strength goals.

The Simple Shoulder Test (SST) is a simple and short patient-reported outcome measuring functional limitations of the affected shoulder in patients with shoulder dysfunction. Although it is widely used in different clinical cultures, literature review to date revealed that the SST has not been yet translated nor validated in the Arabic language. To translate, culturally adapt, and validate the Arabic version of the Simple Shoulder Test (SST). A forward-backward translation method was adopted. One hundred and forty-one patients with shoulder pain were recruited for psychometric analysis based on the inclusion criteria. The test-retest reliability of the Arabic SST (ASST), pain, disability and total scores were assessed using intraclass correlation coefficients (ICC). The construct validity of the ASST was tested by Spearman rank coefficients through comparing the Arabic SST scores to the severity of shoulder pain measured using the visual analogue scale (VAS) and the Arabic version of the Shoulder Pain and Disability Index (SPADI). Internal consistency was assessed by the Cronbach's alpha. One hundred and forty participants (60 males and 80 females) with a mean (Standard Deviation) age of 39.3 (4.9) years participated in the study. The ICCs for score of ASST were reported high; pain 0.84 (0.78-0.93), disability 0.96 (0.93-0.97) and total score 0.95 (0.91-0.97). Similarly, the Cronbach α values for the ASST scores were also of high values with regards to pain (0.89), disability (0.94), and total score (0.97) respectively. Comparing the scores between the first and the second use of the ASST revealed no statistically significant mean differences of -1.9 (95% CI-3.61 to 0.17). The Arabic-translated version of the SST showed high reliability, internal consistency, and construct validity based on substantial correlations of the ASST with Arabic SPADI and VAS. We recommend the Arabic version of the SST for the evaluation of Arabic-speaking patients with shoulder dysfunction.

[This corrects the article DOI: 10.1371/journal.pone.0253155.].

Self-reported physical activity questionnaires (e.g., International Physical Activity Questionnaire, IPAQ) are a cost-effective, time-saving, and accessible method to assess sedentary behaviour and physical activity. There are conflicting findings regarding the validity of self-reported questionnaires in comparison to accelerometer-measured data in a free-living environment. This study aimed to investigate the concurrent validity between self-reported Arabic–English IPAQ short form (IPAQ-SF) and Fibion (Fibion Inc., Jyväskylä, Finland) accelerometer-measured sedentary and physical activity time among young adults. One hundred and one young healthy adults (mean age 20.8 ± 2.4 years) filled in the IPAQ short form (IPAQ-SF) and wore the Fibion device on the anterior thigh for ≥ 600 min per day for 4–7 days. Concurrent validity between the IPAQ-SF and Fibion accelerometer for sitting, walking, moderate activity, and vigorous activity time was assessed using the Spearman correlation coefficient ( ρ ) and Bland–Altman plots. Significant weak associations between IPAQ-SF and Fibion measurements were found for total activity time ( ρ = 0.4; P  < 0.001) and for the duration of walking ( ρ = 0.3; P  = 0.01), moderate ( ρ = 0.2; P  = 0.02), and vigorous-intensity activities ( ρ = 0.4; P  < 0.001). However, ρ was not significant ( ρ = − 0.2; P  = 0.09) for sitting time. In addition, all the plots of the measured variables showed a proportional bias. A low association and agreement were found between self-reported IPAQ-SF scores and Fibion accelerometer measurements among young adults in the UAE. Adult sedentary and physical activity measurements should be obtained objectively with accelerometers rather than being limited to self-reported measures.

There are two primary ways of accessing physiotherapy for service users around the world. The direct access, as opposed to the indirect access which requires a referral from a general physician, has several merits including better quality, timeliness, cost effectiveness of treatment and better probability of preventing acute conditions from turning into chronic ailments. Despite these benefits, several countries including the UAE, do not allow direct access to physiotherapists. This study aims to understand the level of awareness among practicing physiotherapists in the United Arab Emirates (UAE) about direct access and to determine whether any of their demographic variables influence the way they perceive the concept. Further, the study sought to explore the perceived barriers and benefits of direct access according to the participating physiotherapists. An observational cross-sectional study was employed. The questionnaire survey developed by Bury and Stokes in 2013 was adapted and employed in this study. The instrument had six sections with close-ended items using a Likert five-point scale to rate them. Two hundred and sixty-four physiotherapists answered the questionnaire shared with them through a web link. Finally, MANOVA was employed to explore any influence of demographic variables on the opinions of the respondents. The findings showed that 70% of participants were aware about direct access while nearly 30% were completely unaware. Younger physiotherapists were more willing to endorse the practice whereas older ones were more apprehensive of the barriers. The main barriers reported were the limited support from the physicians and policy makers, professional autonomy, and the limited scope of practice for the physiotherapists, as well as evidence-based practice. The impact of demographic variables on direct access indicated that physiotherapists under the age of 23 endorsed direct access more strongly than other age groups. More efforts are needed to implement direct access in the UAE, considering the benefits of improved professional status, cost savings, patient satisfaction, and higher efficiency. This study recommends leadership support, professional autonomy, and mentorship as possible ways to achieve this goal.

This pilot study primarily aimed to detect the adherence as well as the effect size required to estimate the actual sample size needed for a larger scale study to compare and evaluate the effectiveness of two extracorporeal shock wave therapy (ESWT) protocols along, with a physical therapy program in reducing pain and improving function among patients suffering from plantar fasciitis. The study also aimed to report the effects of the ESWT protocols used on pain and function. A total of 26 participants took part in the study, including 17 females and 9 males. The average age of the participants was 34 years with a body mass index (BMI) of 23 kg/m2. Participants were divided into three equal groups; Group A received ESWT at a frequency of 15 Hz and intensity of 3, Group B received ESWT at a frequency of 10 Hz and intensity of 4, while Group C underwent the selected physical therapy program along with sham shock wave therapy as a control. Pain levels were assessed using the Visual Analog Scale (VAS) while functional improvements were evaluated using the Foot Function Index (FFI). Data was collected prior to treatment, after three sessions and at the end of six weeks (after six sessions). The three groups were well matched, and the results revealed high adherence rates (90%, 90% and 80% respectively). Results also indicated reductions in pain levels and improvements in function for both intervention groups when compared to the control group. Group A demonstrated better outcomes compared to Group B while Group C showed relatively less improvement. The study concluded a high adherence rate for the three groups as well as a small effect size detected of 0.282 that would suggest a total of 123 participants to be required to replicate the study on a larger scale. With regards to the findings of this pilot, the combination of ESWT and a targeted physical therapy program revealed a possible effective therapeutic approach for plantar fasciitis, with a higher frequency potentially yielding more favourable results.

Ankle instability is a common injury in athletes, affecting the quality of life, functional limitation, as well as static and dynamic balance. The aim of the study was to compare the efficacy of virtual reality and Biodex balance training in the treatment of ankle instability in adolescent athletes. Ninety football players were enrolled in this study after the assessment of their eligibility. Their age ranged from 12 to 16 years. They were randomly allocated to three groups of equal numbers. Group 1 received a guideline protocol, group 2 received the same guideline protocol in addition to Wii Sport Training, and group 3 received the same guideline protocol in addition to Biodex balance training. All groups received treatment protocols three times a week for 3 months. Outcome measures included the stability indices (overall stability, anteroposterior stability, and mediolateral) measured by the Biodex Balance System as well as ankle instability measured by the Cumberland Ankle Instability Tool. Measurements were collected at the baseline and after 3 months of treatment. Post-treatment findings revealed a statistically significant decrease in the overall, anteroposterior, and mediolateral stability indices, as well as significant increase in Cumberland Ankle Instability outcomes of all groups ( < 0.05). On the other hand, there were no statistically significant differences between the virtual reality and Biodex balance training groups. Virtual reality training has a significant effect which appears to be similar to the Biodex balance training in adolescent athletes with chronic ankle instability.

Human biomonitoring is crucial for regulatory toxicology, yet data on biomarker concentrations in the UAE are lacking. This study addresses this gap by analyzing urinary concentrations of 16 metals in UAE young adults, assessing correlations with personal characteristics, dietary patterns, and lifestyle habits. A cross-sectional pilot study was conducted among 144 randomly selected young adults (71 males and 73 females) from Sharjah, UAE, between January and March 2023. Participants provided urine samples, which were analyzed for 16 heavy metals using ICP-OES, and completed detailed questionnaires covering sociodemographic factors, lifestyle, and dietary habits. Descriptive statistics were used to summarize participant characteristics, and linear regression analysis was applied to explore associations between metal concentrations and factors such as gender, dietary habits, and exposure to environmental risks. Non-parametric tests, including the Mann-Whitney test, were used to assess differences by gender. Statistical significance was set at p < 0.05. Ethical approval was obtained, and informed consent was secured before participation. Significant findings include dietary influences on metal exposure, with rice consumption linked to higher metal concentrations. Sex differences were significant, with females showing elevated levels of arsenic, lead, and cadmium. Lifestyle factors, such as smoking and incense use, were correlated with increased barium and boron levels. This study highlights the significant role of dietary habits, especially the consumption of rice, in metal exposure among young adults in Sharjah. The findings highlight the urgent need for comprehensive human biomonitoring to understand environmental exposures and reform public health policies. The gender-specific differences in metal distribution suggest the necessity for targeted public health strategies. The study, however, is limited by its cross-sectional nature and the focus on a specific geographic area, warranting further research for broader generalizability. Future investigations, particularly on the impact of incense exposure on metal levels, are essential for developing comprehensive health interventions and preventive strategies in the UAE.