European journal of physical and rehabilitation medicine最新文献

Background: Stroke is a highly prevalent and disabling acute cerebrovascular disease. Existing assessment methods for hemiplegic patients have subjectivity, and research on combining surface electromyography and color Doppler ultrasound (CDUS) to evaluate lower limbs of stroke patients is scarce.

Aim: The study explored the correlation between quadriceps femoris muscle function and femoral artery hemodynamic parameters in hemiplegic patients after stroke for more accurate rehabilitation assessment.

Design: A prospective control study.

Setting: Hospital in-patient population.

Population: The sample comprised 20 post-stroke hemiplegic patients aged 18 - 80 years who met specific inclusion and exclusion criteria. Then the healthy side and the affected side were compared respectively.

Methods: The study chose surface electromyography and color Doppler ultrasound. Femoral artery hemodynamic parameters and quadriceps femoris electromyographic signals were detected before and after maximum isometric contraction. Differences between the affected and healthy sides and correlations were analyzed.

Results: The affected side had lower peak systolic velocity, arterial diameter, and surface electromyography indicators of the quadriceps femoris (except for increased end-diastolic velocity) (P<0.05). Significant differences were found in mean power frequency and median frequency of vastus medialis and vastus lateralis muscles (P<0.05). A positive correlation was found between the healthy side's quadriceps femoris median frequency and arterial diameter during contraction (r=0.489, P<0.05).

Conclusions: Lower limb muscle function impairment in hemiplegic patients after stroke is closely related to hemodynamic abnormalities. Combining surface electromyography and CDUS provides comprehensive rehabilitation assessment.

Clinical rehabilitation impact: This combined method can reduce subjective bias of traditional assessment, improve early assessment accuracy, and provide more precise references for stroke rehabilitation assessment and treatment.

Background: Chronic obstructive lung disease is diverse and complex, exhibiting pulmonary and systematic symptoms that interrupt the patients' daily activities and sleep. The most frequent source of these symptoms is air stacking, which can be lessened by positive expiratory pressure Buddy, a simple and affordable device.

Aim: This study aimed to assess the impact of positive expiratory pressure Buddy during exercise on pulmonary function, functional performance, and sleep quality among those patients.

Design: Randomized controlled study.

Settings: Faculty of Physical Therapy, Cairo University, Outpatient Clinic.

Population: Sixty patients with moderate-to-severe chronic obstructive lung disease, aged 55 to 65.

Methods: The participants were allocated evenly into two groups: the experimental group, which used the positive expiratory pressure Buddy while doing the aerobic exercise, and the control group, which did the same aerobic training without using the PEP Buddy. Spirometry (forced expiratory volume in 1 second and forced expiratory volume in 1 second/forced vital capacity ratio), dyspnea, a six-minute walk test distance, sleep quality, and quality of life (St. George Respiratory Questionnaire) were used to evaluate the patients both before and after the study's eight-week timeframe.

Results: The experimental group showed higher significant improvements in all assessed parameters than the control group after eight weeks of intervention (P<0.001).

Conclusions: When combined with a regular exercise regimen, positive expiratory pressure Buddy is an extremely adherence intervention that improves sleep, exercise capacity, pulmonary function, and general quality of life. Thus, it can be considered an excellent choice for patients receiving at-home treatment.

Clinical rehabilitation impact: Chronic obstructive pulmonary disease is a major global health issue that affects society, healthcare systems, and patients' health and quality of life. Its management is still challenging, necessitating the use of alternative therapy approaches.

Background: Stroke rehabilitation - both inpatient and community - is an important part of current post-stroke care, aimed at improving outcomes. However, there is a lack of recent New Zealand research exploring associations between rehabilitation and health-related quality of life (HRQoL) post stroke.

Aim: To explore associations between stroke rehabilitation and HRQoL.

Design: Secondary analysis of data from a prospective, observational study.

Setting: Twenty-eight New Zealand hospitals.

Population: Overall, 2379 patients with stroke.

Methods: Data was collected from consecutive patients with stroke who were admitted to New Zealand hospitals between 1^st May and 31^st July 2018. Further data collection occurred until the target sample size was reached, or until 31^st October 2018, whichever occurred first. Patients were contacted for routine follow-up at three months and were invited to consent to follow-up at six and 12 months. We used the EQ-5D-3L and calculated the health utility score using weightings for the New Zealand population. We used linear regression to explore correlations between rehabilitation and HRQOL, adjusting for known confounders including stroke severity.

Results: There were 750/2379 (31.5%) patients who received inpatient rehabilitation and 838/2379 (35.2%) who received community rehabilitation. In a multivariate analysis, patients who received inpatient rehabilitation, compared to people who did not, had lower HRQoL scores at both three months (-0.07, 95% CI -0.10 to -0.04) and 12 months (-0.08, 95% CI -0.12 to -0.04). Patients who received community rehabilitation had higher HRQoL scores at 12 months (0.04, 95% CI 0.002 to 0.08)). Stratifying scores by stroke severity, we found results in favor of inpatient rehabilitation for only the most severely impaired patients and for community rehabilitation for all but the least impaired.

Conclusions: We found a negative correlation between HRQoL and inpatient rehabilitation, and a positive association between HRQoL and community rehabilitation. A combination of personal, environmental and service factors may explain this result. Future research directly comparing outcomes for patients receiving comprehensive community-based and inpatient rehabilitation, would be useful to support stroke rehabilitation service development.

Clinical rehabilitation impact: Individualized rehabilitation planning should consider social supports, the home environment, functional level and patient preference to support decision-making around rehabilitation location and optimize outcomes.

Background: Lower limb dysfunction is common after stroke. While physical rehabilitation is the most widely used treatment, its effectiveness is limited in improving motor function.

Aim: This study aimed to investigate the effect of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) combined with motor imagery (MI) on lower limb motor dysfunction in cerebral infarction patients.

Design: A randomized, double-blind, and controlled study.

Setting: The Rehabilitation Department of a single Hospital.

Population: Sixty patients with lower limb motor impairment post-cerebral infarction were randomly allocated to the rTMS group, the MI group, and the combined rTMS + MI group.

Methods: All groups received standard physical rehabilitation training and the allocated treatment for 3 weeks. Motor function was evaluated before and after intervention with the Fugl-Meyer Lower Extremity Motor Function Scale (FMA-LE), Holden Walking Functional Classification (FAC), and Time-Up-Go Time Test (TUGT). Magnetic resonance diffusion tensor imaging (DTI) was used to assess fractional anisotropy (FA) and the bilateral FA ratios (rFA) in the corona radiata, cerebral peduncles, posterior limb of the internal capsule, and infarction foci.

Results: The combined treatment increased lower limb motor function (FMA-LE), walking ability (FAC levels), and functional mobility of the lower limb (TUGT), compared to patients receiving MI therapy alone. The combined treatment also had a superior effect to rTMS alone on walking ability. Furthermore, DTI findings demonstrated a more prominent increase in FA and rFA, mainly in the corona radiata, posterior limb of the internal capsule, and the infarcted foci following the combined treatment.

Conclusions: LF-rTMS combined with MI could significantly enhance lower limb motor function in cerebral infarction patients, potentially by promoting neuroplasticity and functional connectivity along the motor pathways. Due to a lack of control group, much of the observed recovery was likely due to spontaneous improvement, given that our patients were in the sub-acute phase of stroke with mild to moderate motor impairment.

Clinical rehabilitation impact: This novel therapy provides a promising approach for improving lower limb motor recovery in stroke rehabilitation.

This article has been retracted by agreement between the authors, Editors and Publisher. The author responsible for managing the ethics committee's approval (B.R.) acknowledges full responsibility for the absence of the requested contact information for the local ethics committee, which was also not included in the official approval documentation. The other authors were not involved in this aspect and bear no responsibility for this omission.

Background: Multi-wave locked system (MLS) laser therapy has shown efficacy in reducing pain in various musculoskeletal conditions. However, its standalone effects on pain and function in patients with chronic non-specific neck pain (CNNP) remain unclear.

Aim: The aim of this study was to evaluate the effects of MLS laser therapy on pain, function, and disability in patients with CNNP compared to a placebo treatment.

Design: Randomized controlled study.

Setting: Outpatient.

Population: Patients aged 20-65 years with CNNP and a neck pain score between 4 and 7 on a Visual Analogue Scale.

Methods: Forty-seven patients were randomized into two groups: MLS Laser and Sham Laser, receiving 8 sessions of their respective treatments. Assessments were conducted at baseline (T0), end of therapy (T1), and one month post-therapy (T2) for neck pain (VAS), function (kinematics and electromyography of head movements), and disability (Neck Disability Index, NDI). Within- and between-group differences were analyzed across these time points.

Results: The MLS Laser group showed significant improvements (P<0.05) in the range of motion for head lateral bending and rotation compared to the Sham Laser group, which exhibited no changes. Both groups demonstrated increased movement velocity (P<0.05) and reduced pain and disability scores (P<0.05). However, either VAS and NDI did not reach the thresholds for minimal clinically important differences (MCID). At T2, a trend towards greater pain reduction was observed in the MLS Laser group (P=0.05).

Conclusions: Both MLS Laser and Sham Laser therapies resulted in statistically significant improvements in pain, disability, and movement velocity. However, these changes were not clinically meaningful. MLS Laser therapy provided more pronounced and sustained pain relief and improved range of motion in head movements.

Clinical rehabilitation impact: MLS Laser therapy improves neck range of motion as a standalone treatment for chronic non-specific neck pain, despite similar effects on pain and disability reduction with placebo.

Introduction: Conservative treatment based on physiotherapy is the first option for non-tears rotator cuff related shoulder pain (RCSP). Although several studies demonstrate the positive effect of therapeutic exercise, aspects such as the influence of supervised exercises versus home-self training or the level of adherence are still unclear. The objective is to study the effect of home exercise programs compared to supervised exercise, either alone or combined with standard physiotherapy treatment.

Evidence acquisition: Web of Science, PubMed, SCOPUS, EMBASE, trials registries and reference lists with relevant articles were searched up to March 2025. Only randomized controlled trials were included that aimed to compare the effect of a home exercise program in patients versus supervised exercise, either in isolation or with usual physiotherapy. The PEDro scale and the Cochrane Collaboration tool were used to evaluate the quality of the studies and the risk of bias, respectively. Exercise Interventions Content Assessment, using the proforma provided in the CERT, and adherence were extracted from the included manuscripts. Data were extracted by two independent assessors using a standardized form. Meta-analyses were conducted with the R statistical program using fixed or random effects models according to the heterogeneity assessed with I² coefficient.

Evidence synthesis: Twelve RCTs (N.=475) were included. Home self-training was similar and no differences were found at 12 weeks from supervised exercise program, either alone or combined with standard physiotherapy treatment on Visual Analogic Scale (VAS) (SMD, 0.92; 95% CI, 0.58 to 1.26, P=0.66); Constant-Murley Score (CS) (SMD, -0.82; 95% CI, -1.05 to -0-60, P=0.64); and Shoulder Pain and Disability Index (SPADI) (SMD, 1; 95% CI, 0.74 to 1.26, P=0.93). It was impossible to include adherence in the meta-analysis due to the small number of studies reporting this data and the heterogeneity of the criteria for accepting adequate adherence to the prescribed exercise program.

Conclusions: Home self-training might be equally effective as outpatient and supervised exercise, isolated or combined with the usual physiotherapy, in terms of primary outcomes. However, the lack of information on adherence rates, the content of the exercise or how it is performed is worrying. Furthermore, the heterogeneity of the criteria related to treatment adherence and compliance indicates that more literature is needed to relate the effect produced with the type of exercise and therapeutic adherence.

Introduction: Ankle instability reduces functional status in athletes and overall population after orthopedic ankle injuries. Complementary to physical therapy approaches, virtual reality-based interventions (VRBI) that promote exercises in ludic and gamified environments, are being used in reducing ankle instability during ankle rehabilitation. The aim of this systematic review with meta-analysis was to assess the effectiveness of VRBI in improving ankle function status, postural balance and muscle strength in patients with ankle instability.

Evidence acquisition: A systematic review with meta-analysis, previously registered in PROSPERO (CRD42023460797) was conducted aligned with the PRISMA guidelines. Literature search was performed in PubMed Medline, SCOPUS, WOS, CINAHL and PEDro without year of publication and language restrictions up to November 2024. Randomized controlled trials (RCTs) including patients with ankle instability which assessed the effectiveness of VRBI, compared to others, on ankle function status, postural balance, muscle strength, were included. Methodological quality and risk of bias were assessed using the PEDro Scale. Pooled effect was calculated with the Cohen's standardized mean difference (SMD) and its 95% confidence interval (95% CI) in random-effects models, or mean difference (MD) if studies used the same measure. All methodological phases of this meta-analysis were conducted by peers.

Evidence synthesis: Twelve RCTs, providing data from 555 participants with ankle instability (89% males with a mean age of 21.8±6.2 years), were included. The mean methodological quality of the studies included was moderate (5.8±1.3 in the PEDro scale). Our meta-analysis showed that VRBI is largely effective in increasing ankle function status (SMD=0.86; 95% CI 0.24 to 1.49; P=0.007), static (SMD=1.6; 95% CI 0.74 to 2.4; P<0.001) and dynamic balance (SMD=0.81; 95% CI 0.36 to 1.25; P<0.001), and strength of muscles involved in plantar flexion (MD=5.76; 95% CI 0.22 to 11.3; P=0.042) and eversion movements (MD=1.7; 95% CI 0.5 to 2.9; P=0.005).

Conclusions: VRBI is a safe and effective therapy for improving ankle function status, static and dynamic balance and strength of the muscles involved in plantar flexion eversion movements in patients with ankle instability.

Introduction: Repetitive peripheral magnetic stimulation (rPMS) is a non-invasive and painless approach developed for therapeutic intervention in clinical rehabilitation. Chronic musculoskeletal pain (CMP) originates from the musculoskeletal system and leads to disability and fear of pain. It may be an option for CMP treatment, but its effectiveness is still unclear.

Evidence acquisition: PubMed, PEDro, the Cochrane Library, Web of Science, and Embase were searched for relevant literatures according to strict inclusion and exclusion criteria on May 26^th, 2023.

Evidence synthesis: The methodology quality of the included studies was assessed using the Cochrane Collaboration's Risk of Bias tool (ROB 2.0) and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) system. The cumulative effects of available data were processed for a meta-analysis using RevMan software. Eight RCTs with 177 participants were included. All studies were assessed as having some concerns regarding the risk of bias. rPMS significantly reduced pain intensity compared with the control, with a standardized mean difference (SMD) across visual analogue scales (VAS) and numerical rating scales (NRS) was -1.16 (95% CI: -1.56 to -0.76, I²=21%, very low-quality evidence), indicating effective pain relief. For subgroup analysis of patients with chronic low back pain (CLBP), the meta-analysis revealed a remarkable pain relief (SMD=-0.92, 95% CI: -1.67 to -0.17, I²=45%, very low-quality evidence). In addition, rPMS exhibited significant cumulative effects on disability improvement (Oswestry disability index: MD=-6.55, 95% CI: -10.27 to -2.82, I²=0%, very low-quality evidence) but not on kinesiophobia (Tampa scale for kinesiophobia: MD=-1.81, 95% CI: -7.60 to 3.98, I²=0%, low quality-evidence).

Conclusions: This meta-analysis demonstrated that rPMS is an effective method for relieving pain and improving disability in the treatment of CMP, especially for patients with CLBP.