Search

Clinical Scenario: Injuries that affect the groin region are among the most common in football players. To prevent this condition, studies have focused on strengthening the adductors, hip flexors, or abdominal muscles. Recent investigations have used an eccentric-biased exercise (Copenhagen Adduction Exercise [CAE]) that promotes functional and architectural adaptations in the muscle tissue, though its effect on injury risk reduction is unknown. Clinical Question: Can the Copenhagen Adduction Exercise prevent groin injuries in soccer players? Summary of Key Findings: The literature was searched for studies investigating the potential groin injury risk reduction effect of the CAE. (1) Three studies met the inclusion criteria and were used for this appraisal; (2) one study observed a significantly lower injury rate ratio favoring the group that used the CAE program; and (3) 2 studies found similar or higher injury rates in the intervention groups, not supporting the inclusion of the CAE as a preventative tool. Clinical Bottom Line: There is conflicting evidence that usage of the CAE is superior to not performing adductor strengthening exercises in mitigating the risk of sustaining groin injuries. Given the evidence supporting these findings, it is advisable to exercise caution when contemplating the incorporation of the CAE into training regimens aimed at preventing groin injuries. Strength of Recommendation: There is Grade B evidence to suggest that inclusion of the CAE may not be associated with reduced injury rates. [ABSTRACT FROM AUTHOR]

Background: Weakness of the rotator cuff has been reported in patients with subacromial impingement syndrome (SIS). A novel therapeutic approach proposes adding exercises for the core musculature to aid in functional recovery in these patients. Purpose: The aim of this study was to assess the short-term effects of adding a core exercise program to supervised physiotherapy on improve lateral rotator strength and functional outcomes in patients with SIS. Study Design: A pre–post single-group study. Methods: A total of 47 participants with SIS were recruited. All patients were treated with five weeks of supervised physiotherapy plus a core exercise program. The primary outcomes were isometric lateral rotator strength and grip strength, measured with a dynamometer. Secondary outcomes included muscular endurance assessed with the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST), shoulder function with the Constant-Murley (CM) questionnaire, and pain intensity reported using the Visual Analog Scale (VAS). Need a brief statement of statistical approach. Results: At end of the five week intervention, isometric lateral rotator strength showed an increase of 9.2 kg (d = 2.1; p < 0.001) and grip strength an increase of 10.6 kg (d = 2.4; p < 0.001). The CKCUEST showed an increase of 5.6 repetitions (d = 3.7; p < 0.001), the CM questionnaire showed an increase of 30.3 points (d = 4.9; p < 0.001) and the VAS showed a decrease of 3.9 cm (d = 6.0; p < 0.001). All outcomes showed large effect sizes and statistically significant differences. Conclusion: In the short term, adding a core exercise program to supervised physiotherapy showed statistically and clinically significant differences in lateral rotator strength and functional outcomes in patients with SIS. Level of Evidence: Level 3 [ABSTRACT FROM AUTHOR]

Background: Evidence of the effectiveness of physiotherapy, including muscle strength training, coordination training, aerobic exercise, cycling regimen, balance training, gait training, and activity of daily living training, in patients with degenerative cerebellar ataxia (DCA) was insufficient for clinical decision making. We aimed to explore clinical outcomes and examine the parameters associated with physical impairment and activity in people with DCA based on preregistration (PROSPERO: CRD42024493883). Methods: The PubMed, Cochrane Library, CHINAL, and PEDro databases were searched for relevant randomized controlled trials (RCTs). Data extraction, quality assessment, and heterogeneity analyses were conducted. The Grading of Recommendations Assessment, Development, and Evaluation framework (GRADE) was used to assess the quality of evidence, and a meta-analysis was performed. Results: Eighteen RCTs, which included 398 participants, showed a serious risk of bias (RoB) and low certainty of evidence for this primary outcome. For meta-analysis, 315 patients assessed based on the Scale for Assessment and Rating of Ataxia (SARA) were included. Overall, physiotherapy significantly reduced SARA scores (MD = −1.41, [95% CI: −2.16, −0.66]); the subgroup analysis showed that the following interventions exerted significant effects: multi-aspect training program (5 studies, MD = −1.59, [95% CI: −5.15, −0.03]), balance training (3 studies, MD = −1.58, [95% CI: −2.55, −0.62]), and aerobic training (3 studies, MD = −1.65, [95% CI: −2.53, −0.77]). By contrast, vibration (2 studies, MD = −0.56, [95% CI: −2.05, 0.93]) and dual-task training (1 study, MD = 0.24, [95% CI: −6.4, 6.88]) exhibited no significant effects. Conclusion: Physical therapy, especially multi-aspect physical therapy such as muscle strengthening, coordination training, gait training, and ADL training, may reduce DCA symptoms. Further, balance and aerobic training can be added to the program. However, the estimated effect size may change in future studies because of the serious RoB, very low certainty of evidence, and high heterogeneity with SARA as the primary outcome. High-quality RCTs are required to establish evidence for the effectiveness of physical therapy in patients with DCA. Systematic review registration: https://www.crd.york.ac.uk/prospero/display%5frecord.php?RecordID=493883, identifier: CRD42024493883. [ABSTRACT FROM AUTHOR]

Is electrical stimulation (ES) combined with strength training and usual care more effective than usual care alone in increasing the strength of very weak muscles in people with recent spinal cord injury (SCI)? A randomised controlled trial with concealed allocation, intention-to-treat analysis and blinded outcome assessors. Sixty participants with recent SCI were recruited from three SCI units in Australia and Bangladesh. Participants were randomised to either a treatment or control group. A major muscle group of the upper or lower limb with Grade 1 or Grade 2 strength on a standard 6-point manual muscle test was selected. Participants in the experimental group received strength training combined with ES and usual care for the target muscle group over 8 weeks. Participants in the control group received only usual care. Assessments were undertaken by a blinded assessor at baseline and 8 weeks. The primary outcome was voluntary muscle strength on a modified 13-point manual muscle test. The three secondary outcomes were participants' perceptions of strength, function and ability to perform self-selected goals. The mean between-group difference for voluntary strength at 8 weeks was 0.7 out of 13 points (95% CI –0.7 to 2.1), where the clinically worthwhile treatment effect was deemed a priori as 1 point. None of the secondary outcomes demonstrated a clinically important effect. Strength training combined with ES over 8 weeks has a negligible effect on the strength of very weak muscles in people with SCI. ACTRN12621000197831. [ABSTRACT FROM AUTHOR]

Background: Flexible pediatric flatfoot is an anatomical presentation of the foot that is common in children, and its functional impact raises long-term uncertainty. Functional re-education includes strengthening and stretching exercises for the intrinsic and extrinsic musculature of the foot, proposed as an effective conservative treatment. However, to date, there is no systematic review examining its effectiveness in the pediatric population. This systematic review aims to evaluate the effectiveness of functional re-education as a conservative treatment for flexible pediatric flatfoot, determining which exercises are most effective. Methods: A search (PROSPERO: CRD42023391030) was conducted across six databases, resulting in an initial total of 327 studies. Of these, 11 randomized controlled trials (RCTs) met the inclusion criteria, resulting in a sample of 419 children aged 6 to 14 years with a diagnosis of flexible flatfoot. The evaluated studies present variations in diagnostic criteria, types of exercises, and treatment duration. Results: The results indicate that functional re-education is effective in improving the symptomatology and functionality of the foot in children. In particular, exercises targeting the intrinsic musculature proved to be among the most effective treatments, improving the structural development of the medial longitudinal arch. The reviewed literature recommends a minimum treatment duration of eight weeks. Conclusions: Functional re-education represents an effective conservative treatment option for flexible flatfoot in children, positioning it as the treatment of choice for this condition. [ABSTRACT FROM AUTHOR]

Quadriceps weakness after anterior cruciate ligament reconstruction (ACLR) is a well-known phenomenon, with more persistent quadriceps weakness observed after ACLR with a bone-patellar tendon-bone or quadriceps tendon autograft than with a hamstring tendon autograft. Longstanding quadriceps weakness after ACLR has been associated with suboptimal postoperative outcomes and the progression of radiographic knee osteoarthritis, making the recovery of quadriceps size and strength a key component of ACLR rehabilitation. However, few articles have been written for the specific purpose of optimizing quadriceps size and strength after ACLR. Therefore, the purpose of this review article is to integrate the existing quadriceps muscle basic science and strength training literature into a best-evidence synthesis of exercise methodologies for restoring quadriceps size and strength after ACLR, as well as outline an evidence-informed quadriceps load-progression for recovering the knee's capacity to manage the force-profiles associated with high-demand physical activity. Level of Evidence: 5 [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusion\nIMPLICATIONS FOR REHABILITATIONTo verify the number of patients with COPD responders to two different home-based rehabilitation programs.This was a blinded, randomized, and controlled clinical trial. The six-minute step test (6MST), one-minute sit-stand test (1-MSTST), six-minute walk test (6MWT), COPD Assessment Test (CAT), modified Medical Research Council (mMRC), monitoring of physical activity in daily life, and isometric quadriceps muscle strength were assessed pre- and post-intervention. A total of 50 patients were randomized into two groups: hybrid rehabilitation (HR), consisting of supervised physical exercise once a week associated with exercises at home, and home-based rehabilitation (HBR), which consisted of a single meeting for guidance related to the physical exercises prescribed.Significant differences (p < 0.05) were observed in the following parameters post-intervention and between groups: 6MST (HR = 67.1 ± 25.7 to 93.5 ± 37.2; HBR = 69.6 ± 19.5 to 82.3 ± 25.2 steps), 6MWT (HR = 367.7 ± 84 to 433.2 ± 88.8; HBR = 396.2 ± 97.2 to 418.3 ± 83.8 m), CAT (HR = 19.5 ± 6.8 to 13.0 ± 7.8; HBR = 17.0 ± 7.6 to 15.0 ± 10 points), and mMRC (HR = 2[2-3] to 1[1-2]; HBR = 2[2-3] to 2[1-3] points). However, the response rate was 80% in the HR and 50% in the HBR.Both pulmonary rehabilitation programs improved physical capacity, alleviated dyspnea, and reduced the impact of the disease on health status; however, the number of responders was higher in the HR.Hybrid rehabilitation (HR) and home-based rehabilitation (HBR), tested and implemented based on the performance in functional tests, improve physical capacity, the sensation of dyspnea, and quality of life of patients with chronic obstructive pulmonary disease (COPD).Hybrid rehabilitation (HR) and home-based rehabilitation (HBR), could be recommended as alternatives to conventional pulmonary rehabilitation (PR).Home-based PR programs, individually prescribed based on functional tests, may be accessible options for the rehabilitation of patients with COPD under no treatment. [ABSTRACT FROM AUTHOR]

Background: This investigation assessed the effectiveness of muscle energy and joint mobilisation techniques on range of motion, pain and functional ability in adults with frozen shoulder. Methods: Relevant RCTs from a 10‐year period, or from 2013 to September 28, 2023, were looked for in databases including PubMed, PEDro, and Google Scholar. Two reviewers independently screened the literature and a third reviewer intervened to resolve the conflict. Risk of Bias assessment was done by the PEDro scale and the certainty of evidence was checked using the Grading of Recommendations, Assessment, Development and Evaluation at three time points. The final articles were systematically summarised. Results: A total of 9 studies comprising 439 subjects were selected for data extraction. Overall joint mobilisation technique and muscle energy technique both tended to be more effective than conservative management but there was a low to very low level of certainty for the effectiveness of muscle energy technique and joint mobilisation technique for frozen shoulder at short term, medium term and long‐term time points. Conclusion: This review indicates that current evidence for managing frozen shoulder with joint mobilisation and muscle energy techniques is limited and of low quality. However, positive outcomes in most studies suggest potential benefits in pain relief, range of motion, and function, suggesting they could be useful adjuncts to conventional treatment. [ABSTRACT FROM AUTHOR]

Objective: This case report describes the physiotherapy treatment of a soldier who suffered a severe combat blast injury. Methods: A 38-year-old Ukrainian man sustained blast injuries while driving over a mine during his service in the Ukrainian army. After receiving acute treatments, he was transferred to an academic hospital in the Netherlands. There, the man presented with severe soft tissue injuries on his back, as well as injuries to multiple organs, including the sciatic nerve and sacrum. Due to these injuries, the man could only lie in a prone position. His treatment goal was to be able to walk again. Results: The patient started physiotherapy, focussing on range of motion, strengthening the leg muscles, and functional transfers. Four months after the injury, he was able to achieve a standing position using a tilt table. Subsequent exercises were conducted to enable independent walking with a scale walker and, eventually, crutches. Seven months after the injury, the patient was transferred to a military rehabilitation centre. Rehabilitation efforts continued to increase joint mobility, improve muscle strength, build stamina with hydrotherapy, and enhance independence. Thirteen months after the blast injury, the man was independent in daily activities and could walk two kilometres without walking aids. Conclusion: This case report presents the challenging yet successful physiotherapeutic treatment of a soldier who suffered a blast injury. A dedicated multidisciplinary treatment team, progressive mobilisation with walking aids, targeted exercises, and the creative use of supportive materials contributed to the patient's recovery to independent daily functioning. [ABSTRACT FROM AUTHOR]

Background: Blood flow restriction training (BFR-t) data are heterogeneous. It is unclear whether rehabilitation with BFR-t after an anterior cruciate ligament (ACL) injury is more effective in improving muscle strength and muscle size than standard rehabilitation. Purpose: To review outcomes after an ACL injury and subsequent reconstruction in studies comparing rehabilitation with and without BFR-t. Study Design: Systematic review. Level of evidence, 3. Methods: A search of English-language human clinical studies published in the past 20 years (2002-2022) was carried out in 5 health sciences databases, involving participants aged 18-65 undergoing rehabilitation for an ACL injury. Outcomes associated with muscle strength, muscle size, and knee-specific patient-reported outcome measures (PROMs) were extracted from studies meeting inclusion criteria and compared. Results: The literature search identified 279 studies, of which 5 met the selection criteria. Two studies suggested that BFR-t rehabilitation after an ACL injury improved knee or thigh muscle strength and muscle size compared with rehabilitation consisting of comparable and higher load resistance training, with two studies suggesting the opposite. The single study measuring PROMs showed improvement compared to traditional rehabilitation, with no difference in muscle strength or size. Conclusion: BFR-t after an ACL injury seems to benefit muscle strength, muscle size, and PROM scores compared with standard rehabilitation alone. However, only 1 large study included all these outcomes, which has yet to be replicated in other settings. Further studies utilizing similar methods with a common set of outcome measures are required to confirm the effects of BFR-t on ACL rehabilitation. [ABSTRACT FROM AUTHOR]

Clinical Scenario: Knee osteoarthritis (KOA) is a complex progressive synovial joint disease that results in impaired muscle function, including a considerable loss of maximal strength and power. Exercise therapies, such as sensorimotor or balance training and resistance training, are frequently used to improve muscle function, mobility, and quality of life, but their impact on maximal muscle strength in patients with KOA is not well understood. Focused Clinical Question: Does sensorimotor or balance training improve knee-extensor and knee-flexor maximal muscle strength compared with strength training or no intervention in patients with KOA? Summary of Key Findings: Results from 4 fair- to good-quality randomized controlled/clinical trials (level 1b) revealed inconsistent grade B evidence regarding the effect of sensorimotor or balance training to improve knee-extensor and knee-flexor maximal muscle strength in patients with KOA. Two studies, one good-quality study and one fair-quality study, showed significant strength improvements, and 2 good-quality studies demonstrated no significant strength enhancements. Clinical Bottom Line: Sensorimotor or balance training may be useful to improve maximal strength of quadriceps and hamstring muscle groups in patients with KOA; however, it seems that this depends on a training duration of at least 8 weeks and the use of unstable devices to induce destabilization of patients' balance, initiating neuromuscular adaptations. Strength of Recommendation: Due to inconsistent evidence (grade B), the true effect of sensorimotor or balance training to improve knee-extensor and knee-flexor maximal muscle strength in patients with KOA remains unclear and needs to be further investigated. [ABSTRACT FROM AUTHOR]

Context: Pulsed current and kilohertz frequency alternating current are 2 types of neuromuscular electrical stimulation (NMES) currents often used by clinicians during rehabilitation. However, the low methodological quality and the different NMES parameters and protocols used in several studies might explain their inconclusive results in terms of their effects in the evoked torque and the discomfort level. In addition, the neuromuscular efficiency (ie, the NMES current type that evokes the highest torque with the lowest current intensity) has not been established yet. Therefore, our objective was to compare the evoked torque, current intensity, neuromuscular efficiency (evoked torque/current intensity ratio), and discomfort between pulsed current and kilohertz frequency alternating current in healthy people. Design: A double-blind, randomized crossover trial. Methods: Thirty healthy men (23.2 [4.5] y) participated in the study. Each participant was randomized to 4 current settings: 2 kilohertz frequency alternating currents with 2.5 kHz of carrier frequency and similar pulse duration (0.4 ms) and burst frequency (100 Hz) but with different burst duty cycles (20% and 50%) and burst durations (2 and 5 ms); and 2 pulsed currents with similar pulse frequency (100 Hz) and different pulse duration (2 and 0.4 ms). The evoked torque, current intensity at the maximal tolerated intensity, neuromuscular efficiency, and discomfort level were evaluated. Results: Both pulsed currents generated higher evoked torque than the kilohertz frequency alternating currents, despite the similar between-currents discomfort levels. The 2 ms pulsed current showed lower current intensity and higher neuromuscular efficiency compared with both alternated currents and with the 0.4 ms pulsed current. Conclusions: The higher evoked torque, higher neuromuscular efficiency, and similar discomfort of the 2 ms pulsed current compared with 2.5-kHz frequency alternating current suggests this current as the best choice for clinicians to use in NMES-based protocols. [ABSTRACT FROM AUTHOR]

Background: Bell palsy is a sudden facial nerve paralysis that affects many individuals annually. It significantly impacts patients and their families, leading to a reduced quality of life if left untreated. The International Classification of Functioning, Disability, and Health (ICF) framework focuses on outcome measures, functional limitations, and overall quality of life of the patients. Early diagnosis is crucial for effective management of the condition. In order to standardize clinical practice and contribute to recommendations of certain interventions, this paper focuses on the optimal dosage of physiotherapy intervention for Bell palsy patients, which includes exercise therapy and electrotherapy. Case presentation: An Indian 33-year-old male visited our physiotherapy department 15 days after being diagnosed with right-sided Bell palsy with unknown aetiology. His chief complaints were right-eye dryness, facial pain, drooping of the face, and difficulty performing facial activities. The outcome measures are the strength duration curve (SD curve), House-Brackmann grading, manual muscle testing, and visual analogue scale (VAS) scale. The physiotherapy intervention includes two primary components: electrotherapy and exercise therapy. Conclusion: The Kabat rehabilitation technique, along with nerve stimulation and an active exercise regimen, is significantly effective in treating Bell palsy, and the outcome measures show significant improvement with optimal therapy dosage. [ABSTRACT FROM AUTHOR]

Background In 2020, the American Society of Shoulder and Elbow Therapists (ASSET) published an evidence-based consensus statement outlining postoperative rehabilitation guidelines following anatomic total shoulder arthroplasty (TSA). Purpose The purpose of this study was to (1) quantify the variability in online anatomic TSA rehabilitation protocols, and (2) assess their congruence with the ASSET consensus guidelines. Methods This study was a cross-sectional investigation of publicly available, online rehabilitation protocols for anatomic TSA. A web-based search was conducted in April 2022 of publicly available rehabilitation protocols for TSA. Each collected protocol was independently reviewed by two authors to identify recommendations regarding immobilization, initiation, and progression of passive (PROM) and active range of motion (AROM), as well as the initiation and progression of strengthening and post-operative exercises and activities. The time to initiation of various components of rehabilitation was recorded as the time at which the activity or motion threshold was permitted by the protocol. Comparisons between ASSET start dates and mean start dates from included protocols were performed. Results Of the 191 academic institutions included, 46 (24.08%) had publicly available protocols online, and a total of 91 unique protocols were included in the final analysis. There were large variations seen among included protocols for the duration and type of immobilization post-operatively, as well as for the initiation of early stretching, PROM, AROM, resistance exercises, and return to sport. Of the 37 recommendations reported by both the ASSET and included protocols, 31 (83.78%) were found to be significantly different between groups (p<0.05). [ABSTRACT FROM AUTHOR]

Objective: A recent study was designed to ascertain the impact of extracorporeal shock wave therapy on upper trapezius trigger points in cervicogenic headaches patients. Design: A double-blinded randomized controlled trial study, in which 50 participants (11 male and 39 female) aged between 20–40 with cervicogenic headache were subdivided with randomization to group (A), which received traditional physical therapy and sham shock wave therapy, and group (B), which received traditional physical therapy and actual shock wave therapy. All assessments were performed by a therapist before and after the treatment program (4 wks). Results: There was a significant difference of headache disability index, visual analog scale scores, and upper trapezius electromyographic characteristics with P value <0.05 in both groups, in favor of the shock wave group. Conclusions: Extracorporeal shock wave therapy could be used for clinical and research concerns because its positive effects on pain suppression, reduction of headache intensity, and restoration of muscle regular activity in cervicogenic headache patients. [ABSTRACT FROM AUTHOR]

A 44-year-old woman suffered a carotid dissection causing a deep and superficial right middle cerebral artery stroke in October 2013, despite undergoing thrombolysis and thrombectomy. Sixteen months later, massive left upper extremity impairment persisted. She then agreed to embark upon a guided self-rehabilitation contract (GSC). This GSC is a moral contract where the physician or therapist identifies specific muscles, particularly hypoextensible and disabling that act as antagonists to functional activities. The physician or therapist then teaches and prescribes quantified daily high-load self-stretch postures for these muscles, alternating with repeated maximal amplitude movement exercises against their resistance. In turn, the patient commits to practicing the prescribed program and to delivering a diary of the stretch postures and alternating movement exercises performed each day. Over 4 years of GSC, the patient practiced upon prescription against a total of seven upper limb antagonists to common functional movements: shoulder extensors, shoulder internal rotators, elbow flexors, elbow pronators, wrist and finger flexors, and interossei muscles. She manually filled up her diary 99% of the days. Each day, she practiced an average of 20 min of high-load static self-stretch per muscle, alternating with about 50 maximal active efforts against the resistance of each targeted muscle's resistance. Overall, her mean static self-stretch time was 81 ± 2 (mean ± SEM) min/day, and her mean number of active maximal efforts was 285 ± 78/day, for a total daily selfrehabilitation time of over 2 h a day. Five years after her stroke, she had recovered all left upper extremity use in daily activities and resumed her previous job as a nurse's aide. She now spontaneously uses her left hand in most tasks. Functional MRI (March 2020) demonstrated bilateral primary motor and motor supplementary area activation upon left-hand exercise. Prolonged static self-stretch increased muscle extensibility (muscle plasticity) while maximal amplitude, alternating movement training reduced co-contraction in these muscles (neural plasticity). The Modified Frenchay Scale assessment was video-recorded by the clinician at each visit, allowing qualitative and quantitative evaluation of the functional capacities. The two videos of the first and last clinic visits have been uploaded and are available. [ABSTRACT FROM AUTHOR]

Objective: This systematic review and meta-analysis aimed to evaluate the influence of core muscle training on throwing ball velocity among overhead throwing athletes. Design: A literature search was performed from inception to July 2023 for randomized controlled trials investigating the effects of core muscle training on overhead throwing ball velocity. The primary outcome was the change in standing throwing ball velocity. The secondary outcome focused on the enhancement of step/jump throwing ball velocity. Results: Ten randomized controlled trials were included, revealing a significant improvement in standing throwing ball velocity in the group undergoing core muscle training (Hedges’ g = 0.701, 95% confidence interval = 0.339 to 1.063, P < 0.001). Longer treatment duration and a higher frequency of core muscle training sessions per week contributed to improved standing throwing ball velocity. However, core muscle training did not show significant benefits for step (Hedge’s g = 0.463, 95% confidence interval = −0.058 to 0.985, P = 0.082) and jump throwing ball velocity (Hedges’ g = 0.550, 95% confidence interval = −0.051 to 1.152, P = 0.073). Conclusions: Core muscle training significantly enhanced standing ball throwing velocity. However, its effect on step/jump throwing ball velocity was less certain. Further research is needed to explore the impact of core muscle training (especially its long-term effects) on throwing ball velocity. [ABSTRACT FROM AUTHOR]

It is clear that clinicians transform lives in the context of rehabilitation, but how can clinicians continue to positively influence patients once they leave rehabilitation and potentially enter into fitness. Group fitness has been shown to be beneficial for older persons in many health outcomes. Clinicians have a tremendous opportunity to ensure success for their patients as they enter into fitness. In this article, we discuss considerations and tactics for clinicians to maximize the potential for their patients' success in group fitness. [ABSTRACT FROM AUTHOR]

Previous studies assessed the effect of extracorporeal shockwave therapy (ESWT) for knee osteoarthritis (OA) among different situations. Thus, results from a meta-analysis regarding this topic may not be reliable due to heterogeneity. A systematic review was conducted on three internet databases, namely Cochrane Library, PubMed, and Embase, gathering pertinent papers from their establishment to March 2024. The search phrases were as follows: "shockwave" OR "shock wave" OR "extracorporeal shockwave" OR "Extracorporeal Shockwave Therapy [MeSH Term]" AND "knee" AND ("osteoarthritis" OR "arthritis" OR "arthritic" OR "osteoarthritis [MeSH term]"). Twenty-four articles (n = 888) were included, with the resulting conclusions demonstrating that ESWT was effective for knee OA compared with sham ESWT; however, ESWT was not effective for patients with severe knee OA. Patients receiving higher energy or higher shock number had significant improvement than those receiving lower energy or less shock number, respectively. Adding ESWT in isokinetic muscular strengthening exercises (IMSE) was more effective than IMSE alone. The efficacy of ESWT was better than other therapies, including intravenously applied prostacyclin and bisphosphonate, corticosteroid injection, kinesiotherapy, hyaluronic acid injection, platelet-rich plasma injection, and physiotherapy. This review demonstrated that ESWT was effective for knee OA. Higher energy and more shock numbers could obtain better efficacy. ESWT could be used as a replacement for some other therapies. [ABSTRACT FROM AUTHOR]

Background: Glenohumeral impingement is one of the common clinical conditions among the overhead athletes. Elite swimmers develop impingement at the glenohumeral joint due to overuse injuries. This type of impingement is due to lack of muscle strength, demanding training session and altered flexibility. Muscle energy technique and positional release therapy are two different manual therapy interventions that may improve joint range and glenohumeral function. Aim: The aim of the study is to compare the effectiveness of positional release therapy and muscle energy technique on glenohumeral impingement among the elite swimmers. Methods: The study included about 40 elite swimmers in which group A (n=20) received positional release therapy with strengthening exercise and group B (n=20) received muscle energy technique with strengthening exercise. The intervention was given for the duration of 4 weeks and the outcome measures used were numerical pain rating scale, range of motion of the glenohumeral joint and the shoulder pain and disability index. Results: The results of the present study were analyzed using Mann Whitney U test and Wilcoxon signed rank test. The pre and post-test values were taken. The results from analysis shows both groups shows statistically significant improvement but group A show highly significant improvement in reducing pain, improving range of motion and shoulder functional ability comparing to group B, 'p' value < 0.05 Conclusion: The study concluded that positional release therapy was effective clinically and statistically shows significant improvement in reducing pain, improving Glenohumeral range of motion and shoulder function. [ABSTRACT FROM AUTHOR]

Objective: To systematically review the randomised controlled trials to evaluate the effects of flexi-bar and non- flexi-bar exercises, specifically stabilization training, on trunk muscle activity in various postures. Methodology: The study included randomized control trials and clinical trials published between 2007-2018, focusing on patients with upper trunk muscle weakness aged above 18. Exclusion criteria included a study with overlapping data, a study with associated disorders, or abstract-only papers. The search strategy involved a search of existing literature from databases like PubMed, Google Scholar, Cochrane Library, PEDro, and Research Gate, removing duplicates and identifying relevant articles. The full-text screening was performed, and the remaining relevant articles underwent data extraction. Surface electromyography (EMG) was used to measure the activity of selected trunk muscles, which was then normalized to maximum voluntary isometric contraction. Result: The findings of this study indicate that flexi-bar exercises resulted in higher activation of trunk muscles compared to non-flexi-bar exercises (stabilization training). The unique physical response induced by the vibration created through the swinging motion of the flexi bar triggered reflexive contractions of core muscles, leading to increased muscle activity. This suggests that flexi bar exercises may be beneficial in promoting muscular activation and potentially alleviating low back pain by evening out muscular imbalances. Conclusion: The results of this study support the use of flexi-bar exercises for activating trunk muscles, particularly when compared to non-flexi-bar exercises (stabilization training). [ABSTRACT FROM AUTHOR]

The purpose of the rehabilitation program is to improve motor skills, coordination, sensory system, mobilization and other existing disorders to achieve activity of daily living (ADL). For a span of five months, beginning two months ago, the patient had been incapable of independent mobilization. Throughout this duration, he was confined to a bed and wheelchair, necessitating assistance from family members for movement, who would lift or carry him as necessary. Physical therapy as part of the multidisciplinary approach can provide core stability exercises, muscular facilitation and stimulation of motion of the upper and lower extremities, balance exercises and mobility exercises, as well as strengthening exercises with PNF facilitation and active stimulation techniques and using the patient's body weight as a training burden. Bobath approach and facilitation exercise can reduce spasticity by strengthening the antagonist muscles. This case report concludes that although physiotherapy is done late with strengthening exercise and core stability strengthening techniques, prone strengthening exercise, it can improve motor skills, coordination, which in turn will increase the patient's independence in carrying out functional activities and ADLs. [ABSTRACT FROM AUTHOR]

Individuals diagnosed with Parkinson's disease (PD) have reported increased incidence rates of falling in comparison to undiagnosed peers. Falls in this population have been found to be related to increasing symptom intensity as well as decreases in overall quality of life. The following examines the effectiveness of balance-based Recreational Therapy within the community setting as part of a multidiscipline treatment team known as the Stillwater Communication, Arts, Nutrition, & Exercise program. A combination of previous data analysis from this longitudinal study have found that participants improved or maintained their physical functioning and reported less occurrences of falling. Treatment protocol focused on strength, balance, and gait-utilizing modalities such as exercise, obstacle courses, boxing training, and tai chi. Data collection of postural stability, or static balance, occurred throughout the 8-month treatment period on a monthly basis and the month 1 and month 8 mean differences were analyzed for statistical and clinical significance. Assessments revealed the successful increase and/or maintenance of overall postural stability through the 8-month treatment period. Results were not statistically significant, yet provide clinical evidence to the effectiveness of RT community- based balance training for individuals diagnosed with PD. The following study builds upon previous evidence that recreational therapy can be an effective treatment option for those who have been diagnosed with PD and potentially others who are experiencing issues with their balance. Implications for future studies and current practice are provided. [ABSTRACT FROM AUTHOR]

Background: Concurrent Exercise Training (CET) is defined as an exercise training mode in which aerobic and resistance exercises are performed in the same session. Objectives: The effects of CET in type 2 diabetes mellitus (T2DM) are inconclusive. Therefore, the objective of the present systematic review with a meta-analysis is to evaluate the effects of CET on metabolic markers, body composition, lipid profile, inflammation, and cardiorespiratory fitness (CRF) in people with T2DM. Methods: Five electronic databases were searched from inception up to January 2023. The eligibility criteria included prospective studies that had T2DM participants aged between 35 and 65 years who performed CET at least 2 times/week for a minimum duration of 8 weeks with a control group. Results: Seven studies were identified for qualitative review. Sufficient data were not available for one study, therefore, meta-analysis was performed in six studies. A significant effect was observed in glucose level (p <.01); glycated hemoglobin (p =.02); Homeostatic Model Assessment for Insulin Resistance (p =.02); body mass index (p =.02); %body fat (p <.01); %fat-free mass (p <.01); waist circumference (p =.03); triglyceride (p <.01); peak oxygen uptake (p <.01); and tumor necrotic factor -α (p <.01). Conclusions: The CET is effective in improving metabolic markers, body composition, lipid profile, inflammation, and CRF in people with T2DM and can be included in the management of T2DM. The overall evidence for this conclusion may be influenced by bias in included studies. [ABSTRACT FROM AUTHOR]

Copyright of Retos: Nuevas Perspectivas de Educación Física, Deporte y Recreación is the property of Federacion Espanola de Asociaciones de Docentes de Educacion Fisica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Context: Neuromobilization exercises (NE) could be a useful therapeutic tool to induce analgesia and increase function and range of motion (ROM) in patients with musculoskeletal pathologies with neuropathic components; however, the effectiveness of this intervention in patients with cervical radiculopathy (CR) is unknown. Objective: To determine the effectiveness of NE in CR on pain, function, and ROM. Design: Systematic review and meta-analysis. Evidence acquisition: An electronic search was performed in the MEDLINE, Scopus, PEDro, and EBSCO databases from inception until June 2022. The authors included randomized clinical trials that evaluated the effectiveness of NE against control groups or other interventions that aimed to treat patients with CR. Evidence synthesis: Seven clinical trials met the eligibility criteria, and for the quantitative synthesis, 5 studies were included. For the studies that compared NE with a control group, the standardized mean difference for pain was -1.33/10 (95% confidence interval [CI], -1.80 to -0.86; P < .01; I2 = 0%), for function with the Neck Disability Index was -1.21/50 (95% CI, -1.67 to -0.75; P < .01; I2 = 0%), and for neck flexion and extensions was 0.66 (95% CI, 0.23 to 1.10; P < .01; I2 = 0%) and 0.47 (95% CI, 0.04 to 0.90; P < .01; I2 = 0%), respectively, with evidence of clinical effectiveness. These findings were based on moderate-quality evidence according to the Grading of Recommendation, Assessment, Development, and Evaluation rating. In studies that compared NE with other interventions, the meta-analysis failed to demonstrate the statistical or clinical superiority of NE. Conclusions: Moderate quality of evidence suggests that NE may be superior to no treatment for pain, function, and ROM in patients with CR. In contrast, NE are not superior to other interventions in the same outcomes, based on low- to very low-quality evidence. More high-quality research is needed to assess the consistency of these results. [ABSTRACT FROM AUTHOR]

Patients with Coronavirus Disease 2019 (COVID-19) who required mechanical ventilation and had prolonged hospital stay present with medical instability and functional impairments after the acute hospitalization. To present the rehabilitation outcome of three patients with COVID-19 admitted to an inpatient rehabilitation unit using a case series method. Subjects included three consecutive male patients admitted to the rehabilitation unit with a diagnosis of deconditioning and critical illness myopathy. On admission, patients were evaluated by a multidisciplinary team using outcome measures such as 6-min walk test (6 MWT), 10-m walk test (10 MWT), berg balance scale (BBS), and dynamometry. Each patient received daily therapy with a minimum of 900 min per week during their rehabilitation stay. Treatment strategies included fatigue management, training of mobility and activities for daily living tasks, muscle strengthening, and cognitive retraining. All patients showed significant improvements across all the outcome measures, specifically, the 6MWT (minimal clinically identifiable difference (MCID) range: 14–30.5 m) and the 10MWT (MCID range: 0.10–0.20 m/s) which exceeded the MCID for all three patients. The BBS also demonstrated significant improvement, surpassing the minimum detectable change of 5–7 points. Of the three patients, two were able to be discharged at an independent level, while one required supervision for safety. Patients with COVID-19, who experienced prolonged hospital stay present with severe impairments in muscle strength, functional mobility, and participation in daily living tasks. Inpatient rehabilitation may have the potential to reduce impairments and accelerate the recovery process while managing ongoing medical issues. [ABSTRACT FROM AUTHOR]

Maintaining independence and quality of life are significant issues for patients with a life-limiting illness and physiotherapists play an essential role in the palliative care multidisciplinary team in maintaining, restoring, and improving physical function and quality of life (QOL). This study aims to describe current physiotherapy interventions utilized in a palliative care service and compare it to the evidence base of physiotherapy interventions in palliative care. An audit was conducted of all inpatient and community palliative care patients referred for physiotherapy review and intervention, over a 4-week period. A literature search was conducted and the level of evidence for individual physiotherapy interventions was assessed. The audit identified 35 patients referred to the Physiotherapist for the assessment and management of mobility, falls risk management and prevention, lymphoedema management and assessment of functional decline. The most frequently performed physiotherapy assessments and interventions were for mobility and transfer (94.3%), falls prevention and management (74.3%), reconditioning and strengthening (57.1%), and exercise prescription (48.6%). Physiotherapy in the palliative care setting is becoming more accepted to help benefit the function and QOL of patients with advanced progressive diseases. This audit highlights the importance of these interventions in assisting patients to manage their symptoms and function at home. [ABSTRACT FROM AUTHOR]

Introduction: People with Amyotrophic Lateral Sclerosis (ALS) can present initially muscle weakness, which is a debilitating symptom that may be improved by engaging in muscle strengthening activities. Currently, the effects of motor interventions for muscle strengthening in people with ALS are unclear. This review intends to analyze the effects of motor interventions for muscle strengthening in individuals with ALS Methods and analysis: Randomized, non-randomized, and quasi-experimental clinical trials assessing individuals with ALS of both sexes, aged 18 years or older, who have received motor interventions for muscle strengthening considering all practices that can lead to increased strength, endurance, power and muscular hypertrophy will be included. No restriction on language, location, or publication date will be applied. MEDLINE, EMBASE, Cochrane Library (CENTRAL), SPORTDiscus, and Physiotherapy Evidence Database (PEDro) databases will be searched. The US National Institutes of Health Ongoing, ClinicalTrials.gov, and the reference lists of included studies will also be searched. Two reviewers will independently screen titles and abstracts and extract data from included studies. The methodological quality of the included studies will be assessed by the PEDro scale and the certainty of the evidence by the GRADE approach. Disagreements will be resolved by a third researcher. Findings will be presented in text and table formats. A meta-analysis will compare the effects of motor interventions for muscle strengthening versus placebo or other interventions. [ABSTRACT FROM AUTHOR]

Introduction: Ankle sprains are the second most common sports injury after knee injuries, with about 85% of them affecting the lateral ankle ligaments. These injuries are particularly prevalent in sports like basketball and volleyball. Purpose: To investigate the effect of Aquatic therapy as an early rehabilitation protocol for elite athletes with acute lateral ankle sprain grade III on back-to-sport time, dynamic balance, pain, Athletic performance, and muscle power compared to land-based exercise training. Methods: Thirty elite athletes have ankle sprain grade III with sprain onset from 1 to 7 days, their age ranges from 18–30 years old were recruited. All participants are professional athletes; mainly participating in above-head sports such as volleyball and basketball. The patients were randomly allocated into two treatment groups: Group I (control group): 15 patients received a conventional physical therapy program of structured therapeutic exercise program, manual therapy and land-based exercises, in addition to external support, and Group II (Aquatic therapy group): 15 patients received aquatic training. Visual Analog Scale (VAS) was used to measure the pain intensity, while the dynamic balance was measured by the Star Excursion Balance Test. Athletic performance was measured by HOP Tests (Single, Triple, 6-m, and Cross-over hops) aided by the Agility T-Test (ATT) and Illinois Agility Test (IAT). Muscle power was tested by a Single Leg Press. Finally, back to sports time was recorded for each participant in both groups. Results: There was a significant interaction effect of Aquatic therapy and time for VAS (p < 0.001), single hop (p < 0.001), triple hop (p < 0.001), cross-over hop (p < 0.001), IAT (p = 0.019) and ATT (p < 0.001) of both affected and nonaffected. There was no significant interaction effect of Aquatic therapy and time for 6-MHT of affected (p = 0.923), and nonaffected (p = 0.140). There was a significant main effect of time for all dependent variables (p < 0.001) except for 6-MHT of affected (p = 0.939), nonaffected (p = 0.109), and IAT (p = 0.099). The Star excursion dynamic balance test (SEBT) and Single leg press revealed a significant difference between groups on affected and non-affected sides (p < 0.001*). Lastly and most importantly the back-to-sport time revealed a significant difference in the return-to-sport time in favor of the Aquatic therapy group who returned faster than the control group (p < 0.001*). Conclusion: Aquatic therapy is more effective than traditional protocols regarding early rehabilitation of acute ankle sprain grade III in Elite professional athletes for reducing pain intensity, improving dynamic balance and athletic performance and power and accelerating their return to sports time. Because aquatic therapy produces better outcomes, it is advised to be included in the rehabilitation programs of athletic patients with acute ankle sprains grade III. [ABSTRACT FROM AUTHOR]

Patellofemoral pain syndrome (PFPS) is one of the most common etiologies of knee pain and might be relieved with lumbopelvic manipulation (LPM). This meta-analysis aimed to investigate the effects of LPM on pain reduction in patients with PFPS. Electronic databases were searched from inception to December 2023 for randomized controlled trials (RCTs) investigating the effects of LPM on PFPS. The primary outcome was the change in visual analog or numeric rating scale scores assessing pain. Ten studies comprising 346 participants were included. Significant pain reduction was noted in the LPM group (Hedges' g = −0.706, 95% confidence interval [CI] = −1.197 to −0.214, p = 0.005, I 2 = 79.624%) compared with the control group. Moreover, pain relief was more pronounced when LPM was combined with other physical therapies (Hedges' g = −0.701, 95% CI = −1.386 to −0.017, p = 0.045, I 2 = 73.537%). No adverse events were reported during the LPM. The LPM appears to be a safe and effective adjuvant therapy for pain reduction in patients with PFPS. Clinicians should consider adding LPM to other physical therapies (e.g., quadriceps muscle strengthening) during the management of these patients. [ABSTRACT FROM AUTHOR]

Although the important roles of proprioception and neuromuscular control in carpal instabilities under laboratory conditions have been recognized, only a few studies have translated this knowledge into a routine clinical practice. This study aimed to evaluate the results of a personalized rehabilitation in patients with carpal instability on functionality and pain intensity. This was a case series study. This case series included 39 adults (mean age: 38.2 ± 14.0 years; 16/23 females/males) diagnosed with carpal instability (radial or ulnar) with indication for orthopedic treatment. The disabilities of the arm, shoulder, and hand questionnaire was used to assess upper limb functionality. Pain perception was assessed using a visual analog scale. Exercise-based physiotherapy interventions were performed according to the clinical needs of the patients for at least 6 weeks (2-3 sessions per week). For the treatment of radial instability (n = 13), strengthening exercises of the abductor pollicis longus, extensor carpi radialis longus, flexor carpi radialis, and pronator quadratus muscles were prescribed. For the treatment of ulnar instability (n = 24), extensor carpi ulnaris and pronator quadratus were trained. All patients underwent proprioceptive training in open kinetic chain and closed kinetic chain, as well as strengthening of the unaffected hand. Changes before and after treatment were compared using the nonparametric Wilcoxon signed rank test. A significant improvement with a large effect size in disabilities of the arm, shoulder, and hand (P <.001; d = 2.9) and visual analog scale (P <.001; d = 3.2) scores were obtained after treatment. Moreover, the changes were greater than the minimal clinically important difference of 10.8 and 1.4, respectively. Similar results were found when patients with radial instability and ulnar instability were analyzed separately. Personalized training with specific proprioception and strengthening exercises produces improvements in functionality and pain perception in our cohort of people with carpal instability. These results highlight the importance of multicomponent exercise in the treatment of wrist instability. Future randomized clinical trials should further investigate the effectiveness of this protocol. • The protocol included strength training exercises combined with proprioceptive and cross-education training. • The combined exercise program showed benefits for function and pain in patients with carpal instability. • This protocol could be a valid alternative as a nonsurgical treatment for carpal instabilities. [ABSTRACT FROM AUTHOR]

Cough is a powerful, protective expulsive behavior that assists in maintaining respiratory health by clearing foreign material, pathogens, and mucus from the airways. Therefore, cough is critical to survival in both health and disease. Importantly, cough protects the airways and lungs from both antegrade (e.g., food, liquid, saliva) and retrograde (e.g., bile, gastric acid) aspirate contents. Aspiration is often the result of impaired swallowing (dysphagia), which allows oral and/or gastric contents to enter the lung, especially in individuals who also have cough dysfunction (dystussia). Cough hyposensitivity, downregulation, or desensitization- collectively referred to as hypotussia- is common in individuals with dysphagia, and increases the likelihood that aspirated material will reach the lung. The consequence of hypotussia with reduced airway clearance can include respiratory tract infection, chronic inflammation, and long-term damage to the lung parenchyma. Despite the clear implications for health, the problem of managing hypotussia in individuals with dysphagia is frequently overlooked. Here, we provide an overview of the current interventions and treatment approaches for hypotussic cough. We synthesize the available literature to summarize research findings that advance our understanding of these interventions, as well as current gaps in knowledge. Further, we highlight pragmatic resources to increase awareness of hypotussic cough interventions and provide support for the clinical implementation of evidence-based treatments. In culmination, we discuss potential innovations and future directions for hypotussic cough research. [ABSTRACT FROM AUTHOR]

Total hip arthroplasty is an effective procedure to improve pain, range of motion, and function for a variety of conditions, including osteoarthritis and posttraumatic arthritis. Up to 28% of patients had persistent pain at the surgical site 12-18 mos after total hip arthroplasty, even in the absence of surgical complications. Currently, there are no widely accepted nonpharmacological treatments for persistent postoperative pain for total hip arthroplasty. This case report details the successful management of a 53-yr-old man with chronic pain and weakness after posttraumatic total hip arthroplasty. He was initially treated with a single-lead percutaneous peripheral nerve stimulator near the right femoral nerve for 4 weeks with 100-Hz frequency sensory-level parameters. Four weeks after implantation, the frequency was changed to 12Hz with a goal of motor-level stimulation. During the after 3-week time period, his hip flexion strength improved from 10.36 kg to 23.04 kg. His Lower Extremity Functional Scale improved from 35/80 (43.75%) to 54/80 (67.5%) within a 5-wk time period. This case's success demonstrates how peripheral nerve stimulation may help improve postoperative persistent pain and weakness in many patients, including those with posttraumatic arthroplasty. [ABSTRACT FROM AUTHOR]

Purpose: The aims of this study are to evaluate the effectiveness of different exercise interventions on patients with adolescent idiopathic scoliosis and to provide evidence-based exercise prescriptions for this population. Methods: The PubMed, Embase, Cochrane Library, Web of Science, CNKI, Chinese Biomedical Literature Database (CBM), VIP, andWanfang Data Knowledge Service Platform were searched until January 2023. The data were pooled and a meta-analysis was conducted. Results: A total of 19 studies were conducted with 778 participants. The Schroth exercises group (mean difference = -3.48, 95% confidence interval = -4.73 to -2.23, P < 0.00001) and strength training group (mean difference = -3.43, 95% confidence interval = -4.06 to -2.80, P < 0.00001) had better recovery of the Cobb angle than the other groups. The Cobb angle rehabilitation effect was good in the time of less than 60-min group. In addition, there was no significant difference found between the different intervention periods groups (P > 0.05). Conclusions: Schroth exercise and strength training significantly improved Cobb angle of adolescent idiopathic scoliosis patients; exercising for less than 60 mins is effective for Cobb angle rehabilitation, but prolonging exercise time cannot improve training effectiveness; 12 wks of exercise significantly improved Cobb angle, but prolonged training periods did not have a significant impact. [ABSTRACT FROM AUTHOR]

Spinal muscular atrophy (SMA) is a neuromuscular ailment that leads to the deprivation of motor neurons in the spinal cord, producing denervation and muscle weakness. This case report explains how a patient with type 2 SMA used a therapeutic exercise rehabilitation program in a school environment. Motor functions were assessed by Gross Motor Function Measure-88 (GMFM-88), Manual Muscle Testing (MMT), and Hammersmith Functional Motor Scale (HFMS), which is validated and reliable. This study employed a repeated pre-test post-test measures design. During a year of treatment sessions, the child underwent twice weekly 45-minute physical therapy sessions for 48 weeks. The research was carried out between March 2022 and February 2023. The purpose of the intervention, which comprised a variety of therapeutic workouts, was to enhance physical function and gross motor abilities in an age-appropriate manner. The intervention utilized in this study led to improvements in GMFM-88, HFMS, and MMT total scores. The results of this case study showed that a child with type 2 SMA aged nine had successfully improved their gross motor skills and muscle strength. [ABSTRACT FROM AUTHOR]

Objective: To examine the effect of adding Maitland mobilization (MM) versus deep cervical flexors muscles training (DCFMT) to conventional physical therapy (CPT) on proprioception in adults with chronic mechanical neck pain (CMNP). Materials and methods: A randomized controlled study was carried out at the outpatient clinics of physical therapy at Cairo and Suez universities. Sixty participants (27 males, 33 females) with CMNP were randomized into 3 equivalent groups. Group I received MM plus CPT, group II received DCFMT in addition to CPT, and group III received CPT only. All individuals were given three sessions a week for 4 weeks. The primary outcomes were proprioception (CROM), and pain (VAS). The secondary outcomes were cranio-vertebral angle (CVA), and upper cervical angle (C0–C2). Outcomes were evaluated at baseline and following 4 weeks of treatment. Results: Following 4 weeks of treatment, the DCFMT group showed statistically significant improvement to the MM group as well as the CPT group in all outcome measures (p > 0.05). Also, the MM group was remarkably better than the CPT group in all measured outcomes (p > 0.05). The mean signed difference (M±SD) post-treatment within the group of VAS were 6.87 ± 1.26, 7.15 ± 1.38, and 7.20 ± 1.39 cm for MM, DCFMT, and CPT groups respectively. The (M±SD) of CVA were 42.61 ± 4.36, 42.24 ± 3.64, and 42.32 ± 4.81 degrees for MM, DCFMT, and CPT groups respectively. The (M±SD) of C0–C2 were 24.25 ± 2.98, 23.37 ± 1.94, and 24.95 ± 3.01 degrees for MM, DCFMT, and CPT groups respectively. The (M±SD) of flexion JPE to target were 3.62 ± 0.91, 2.86 ± 0.77, and 4.35 ± 0.91 degrees for MM, DCFMT, and CPT groups respectively. The (M±SD) of flexion JPE to neutral were 3.96 ± 0.78, 2.66 ± 1.03, and 5.23 ± 1.52 degrees for MM, DCFMT, and CPT groups respectively. Conclusion: Adding MM and DCFMT to CPT revealed significant enhancement, favoring DCFMT, on proprioception, pain, cranio-vertebral angle (CVA), upper cervical angle (C0–C2), and intensity than CPT alone in adults with CMNP. Trial registration: Pan African Clinical Trails Registry with a registration No. PACTR202211651838599 on the 3rd of November 2022. [ABSTRACT FROM AUTHOR]

Copyright of Physiotherapy Canada is the property of University of Toronto Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Diabetic neuropathy (DN) is one of the most complex and progressive disorders, characterized by symmetrical distal degeneration of peripheral nerves, resulting in features of pain and sensory loss. This study aimed to find out the effects of physiotherapy intervention on physical function, balance, and postural control of persons with DN. Materials and Methods: A computerized electronic search was performed using PEDro, Pubmed, CINAHL, and EMBASE with keywords including physiotherapy intervention, physical exercise, rehabilitation techniques, balance training, diabetic neuropathy, and diabetic peripheral neuropathy. The inclusion criteria consisted of studies that were randomized clinical trials, crossover trials, or controlled trials published in the English language from 2015 to 2021, identifying DN as the primary concern, and physiotherapy intervention as one of the treatment options. Results: The primary search of the database turned up an entire set of 58 studies, among which 11 studies were selected as potentially meeting the inclusion criteria. Ultimately, four studies were retained for the final results of the review. The evaluations provided evidence to suggest that physiotherapy has positive effects on subjects with diabetic peripheral neuropathy. Conclusion: After reviewing, it has been revealed that balance and strength training are applicable for improving balance, gait, and physical function in DN patients. [ABSTRACT FROM AUTHOR]

This study aimed to determine the safety, feasibility, and acceptability of physiotherapy (PT) combined with strength training using active video games (AVG) for older patients with musculoskeletal conditions. Sixteen patients underwent AVG + PT on day 1 and only conventional physiotherapy (CPT) on day 2. The AVG was conducted in 6 upper- and lower-limb training performed in standing position using Ring Fit Adventure (RFA) on Nintendo Switch. Outcome measured adverse events and deviant movements associated with the AVG as safety, execution rate of each AVG programme as feasibility, and questionnaires (4-point Likert scale) regarding enjoyment, motivation to continue, and feeling of efficacy as acceptability. The berg balance scale/functional independence measure indicated 45 ± 8/90 ± 16. No adverse events occurred. Some of deviant movements were observed that could be an injury risk, such as a slight forward movement during the stepping exercise. The execution rate for each AVG programme ranged from 81% to 100%. The categories of enjoyment, motivation to continue, and feeling of efficacy had >90% of positive responses (strongly agree, slightly agree) in AVG + PT, and enjoyment tended to be higher in AVG + PT than in CPT. Strength training using RFA was considered to be a safe and feasible exercise tool enough to be applicable as part of a rehabilitation programme in older patients with musculoskeletal conditions. However, should be supervised, at least during the introductory phase. It was also positively accepted by older adults, suggesting enhanced enjoyment. Active video games (AVG) training with Ring Fit Adventure (RFA) was found to be safe enough to be considered for application as part of a rehabilitation programme for older patients with musculoskeletal conditions, but should be supervised, at least during the introductory phase. AVG training comprising strength training with RFA was found to be a highly feasible exercise tool for rehabilitation in older patients with musculoskeletal conditions. Physiotherapy combined with AVG training using RFA was also well received, suggesting enhanced enjoyment for older patients with musculoskeletal conditions. [ABSTRACT FROM AUTHOR]

Key Clinical Message: This case report aims to raise a physiotherapy intervention for subjects with SMS. The basis is an active work, based on postural control and balance training. Physiotherapists can play an important role in the management of these subjects. Smith–Magenis syndrome (SMS) is a genetic alteration that encompasses a series of psychophysical repercussions that interferes with postural control and the autonomous functionality of the subjects who suffer from it. In this study, a clinical case of an 18‐year‐old adolescent with a genetic diagnosis of an SMS mutation is presented. This work proposes a physiotherapy intervention, adapted to the individual conditions and agreed upon with his family. The goal would be to analyze the effectiveness of postural control and balance training in a subject with SMS. A physiotherapy intervention based on postural control and balance was proposed. This approach is combined with the strengthening and readaptation of the antigravity muscles, through strength training, mobilization exercises, gait and transfers reeducation. An initial assessment was carried out. The interventions were developed at the home of the clinical case. The main variables were balance and postural control. For this, the following measurement scales and tests were used: Face Scale, Gross Motor Function Scale, Berg Balance Scale, Romberg Test, Barthel Index, and Functional Assessment of Sitting (SATco scale). After the intervention, the case presented under observation greater postural control in the transfers, less imbalances, and introduced new positions during their development, which allow more functional and autonomous movement. This was also extrapolated to gait, which was optimized in its development. This observation was not reflexed in test scores, which remained the same than the initial assessment. The intervention had a positive effect on the development of trunk control, transfers, and gait. [ABSTRACT FROM AUTHOR]

Physiotherapy plays a major role in long-term management of COPD. The aim of this study was to evaluate the effects of a 4-week muscle energy technique programme on pulmonary function measures, functional endurance capacity, chest wall mobility and ADLs in patients with COPD. A parallel-group, randomised controlled trial was adopted. 108 participants with COPD were recruited and randomly assigned to the intervention or control group. The intervention group received MET interventions, three-times weekly for 4 consecutive weeks, while the control group continued with their standard medical treatment. The study is clinically registered (ClinicalTrials.gov Identifier: NCT04773860). Statistically significant improvements in pulmonary function (p < 0.001), chest measurements (p < 0.001) and ADLs (p < 0.001) were observed for participants in the intervention group when compared to baseline measures. Clinical but not statistically significant improvements in the 6MWT were also noted (p = 0.08), outcomes which were not observed in participants enrolled in the control group. This study concludes that METs can be used as an adjunct with other non-pharmacological treatments for patients with COPD to help manage their shortness of breath, improve their respiratory function and hence, as a result, improve their activities of daily living. [ABSTRACT FROM AUTHOR]

Several interventions using resistance training have been attempted for people with heart failure. Still, the overall effectiveness of resistance training in improving muscle strength and peak oxygen uptake based on age remains inconclusive. This study aimed to investigate the efficacy of resistance training on muscle strength and VO2 peak in patients with heart failure based on age. A search was conducted using English articles from 2000 to 2023 to find information on resistance training from Embase, CINAHL, MEDLINE, Cochrane, PEDro, and Google Scholar. Standardized mean difference and 95% confidence intervals were calculated, and publication biases were presented by funnel plots and Egger's test. The Critical Appraisal Skills Programme was used to examine the quality of the studies. Results showed that 23 randomized control trial articles fulfilled the inclusion criteria, comprising 830 respondents, with 422 in the intervention and 408 in the control group. In the middle-aged subgroup, resistance training had a significant effect on increasing muscle strength in the upper limb and lower limb. Similarly, a significant effect was observed in the older subgroup for the upper limb and lower limb. Resistance training significantly increased VO2 peak in middle-aged and older patients with heart failure. Resistance training was identified as one of the effective ways to improve muscle strength and VO2 peak, and it should be recommended as a part of the rehabilitation for people with heart failure. Additionally, the components of interventions should be considered based on the patient's age to maximize the exercise programs using resistance training. [ABSTRACT FROM AUTHOR]

Objective This systematic review and meta-analysis aimed to evaluate the effects of respiratory muscle training (RMT) on functional exercise capacity, health-related quality of life (HRQoL), respiratory muscle function, and pulmonary function in individuals with ischemic heart disease (IHD). Methods The MEDLINE, Web of Science, Scopus, PEDro, CINAHL, Science Direct, and CENTRAL electronic databases were searched in January 2023. Randomized controlled trials published in English, Spanish, or Portuguese that were conducted to determine the effect of RMT versus passive control and/or sham RMT on the target variables in individuals with IHD, irrespective of age or sex were included. Two reviewers performed the searches and extraction of the most relevant data. The quality and risk of bias for each included study were examined with the PEDro scale and Cochrane risk-of-bias tool. Results Thirteen studies (849 participants) were included. The meta-analysis showed a significant increase in peak oxygen consumption (mean difference [MD] = 2.18 mL·kg−1·min−1 [95% CI = 0.54 to 3.83]), inspiratory muscle strength (MD = 16.62 cm H2O [95% CI = 12.48 to 20.77]), inspiratory muscle endurance (standardized mean difference = 0.39 [95% CI = 0.19 to 0.60]), and expiratory muscle strength (MD = 14.52 cm H2O [95% CI = 5.51 to 23.53]). There were no benefits in 6-minute walking distance (MD = 37.57 m [95% CI = −36.34 to 111.48]), HRQoL (standardized mean difference = 0.22 [95% CI = −0.16 to 0.60]), pulmonary function (forced vital capacity; MD = 2.07% of predicted value [95% CI = −0.90 to 5.03], or forced expiratory volume at the first second (MD = −0.75% of predicted value [95% CI = −5.45 to 3.95]). Conclusion This meta-analysis provided high- and moderate-quality evidence that inspiratory muscle training (IMT) improves inspiratory muscle strength and endurance, respectively; and very low-quality evidence for effects on peak oxygen consumption and expiratory muscle strength in individuals with IHD. No superior effects were found in the 6-minute walking test, HRQoL, or pulmonary function compared with the control group. Impact The results shown in this systematic review with meta-analysis will provide clinicians a better understanding of the effects of IMT in people with IHD. IMT could be integrated into the cardiac rehabilitation management, although more research is needed. [ABSTRACT FROM AUTHOR]

Chronic pain in the elderly is becoming increasingly important and is associated with serious health impacts. Therefore, international guidelines demand that pain therapy for the elderly preferably be a multimodal therapy based on a bio-psycho-social pain model. Specific psychometric tests and interview guidelines are available for the interdisciplinary pain assessment. Evidence for the effectiveness of multimodal pain therapy in the elderly remains limited. However, controlled clinical trials have shown that these patients benefit—especially if the intervention is adapted to their specific needs. The focus of movement therapy is not only muscle strengthening but also coordination exercises. In individual physical therapy and occupational therapy, everyday solutions can be developed for individual physical limitations that are more frequent in old age. In psychological training, pain acceptance, balancing rest and activity, social integration and dealing with aging are particularly important topics. Relaxation and mindfulness techniques can also favorably affect pain and function. Thus, these are popular with patients and are often adopted in everyday pain management. Pain education is considered useful as an adjunctive measure and can also be increasingly supported by digital media in the elderly. Complementary therapy components include confrontational treatment of fear-avoidance beliefs (the German AMIKA scale, Ältere Menschen in körperlicher Aktion, "older people in physical action") and naturopathic applications as an active self-help strategy. Since it is unclear how long the achieved therapeutic effects last, follow-up care is of particular importance in therapy for older patients. [ABSTRACT FROM AUTHOR]

Background: Diminished postoperative knee extension strength may occur after anterior cruciate ligament reconstruction (ACLR) with quadriceps tendon (QT) autograft. Factors influencing the restoration of knee extensor strength after ACLR with QT autograft remain undefined. Purpose: To identify factors that influence knee extensor strength after ACLR with QT autograft. Study Design: Case-control study; Level of evidence, 3. Methods: The authors performed a retrospective review of patients who underwent primary ACLR with QT autograft at a single institution between 2010 and 2021. Patients were included if they completed electromechanical dynamometer testing at least 6 months after surgery. Exclusion criteria consisted of revision ACLR, <6 months of follow-up, concomitant procedure (osteotomy, cartilage restoration), and concomitant ligamentous injury requiring surgery. Knee extension limb symmetry index (LSI) was obtained by comparing the peak torque of the operated and nonoperated extremities. Univariable and multivariable analyses were performed to identify factors associated with knee extension LSI in the patient, injury, rehabilitation, and preoperative patient-reported outcomes score domains. Results: A total of 107 patients (58 male; mean age, 22.8 years) were included. Mean knee extension LSI of the overall cohort was 0.82 ± 0.18 at 7.5 ± 2.0 months; 35 patients (33%) had a value of ≥0.90. Multivariable analysis demonstrated significant negative associations between knee extension LSI and female sex (−0.12; P <.001), increased age at the time of surgery (−0.01; P =.018), and larger QT graft width (−0.049; P =.053). Conclusion: Factors influencing knee extensor LSI after ACLR with QT autograft in this study population spanned patient and surgical factors, including female sex, older age at the time of surgery, and wider graft harvest. Surgeons should consider the association between these factors and lower postoperative knee extensor LSI to optimize patient outcomes. [ABSTRACT FROM AUTHOR]

Clinical Scenario: Knee pathologies often require rehabilitation to address the loss of knee-extensor (KE) strength, function, and heightened pain. However, in the early stages of rehabilitation, higher loads may be contraindicated. Blood flow restriction (BFR) resistance training does not require high loads and has been used clinically to promote strength improvements in a variety of injured populations. BFR resistance training may be an effective alternative to high-intensity resistance training during early rehabilitation of knee pathologies. Clinical Question: Following a knee injury, does BFR resistance training improve KE strength and function, and reduce patient-reported pain? Summary of Key Findings: Four randomized controlled trial studies met the inclusion criteria. Each included study evaluated the use of BFR resistance training on knee pathologies and the effects on KE strength, functional outcomes, and pain compared with high- or low-load resistance training. All 4 studies reported significant improvements in KE strength, function, and pain through a variety of outcome measures, following BFR resistance training use as the treatment. Clinical Bottom Line: There is consistent evidence to support the use of BFR resistance training as a treatment intervention following knee injury and as a means to improve KE strength and function and to reduce pain. Strength of Recommendation: Grade A evidence supporting the use of BFR resistance training for improvement in KE strength and function, and the reduction of patient-reported pain following an acute or chronic knee pathology. [ABSTRACT FROM AUTHOR]