European journal of physical and rehabilitation medicine最新文献

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.

This article has been retracted by agreement between the authors, Editors and Publisher.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.

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.

Background: Visuospatial function is a core domain of functional cognition in stroke. Post-stroke cognitive impairment disrupts rehabilitation practice, highlighting the importance of characterizing patients with higher-order visuospatial dysfunction to inform personalized rehabilitation strategies. Although neuroimaging offers insights into disease-related mechanisms, its clinical application remains limited.

Aim: The aim of this paper was to investigate whether the residual resting-state functional connectivity supports higher-order visuospatial function after stroke and whether changes in connectivity can characterize patients with visuospatial dysfunction.

Design: Observational study.

Setting: Inpatient rehabilitation ward at Fujita Health University Hospital in Japan.

Population: Fifty-eight patients with stroke.

Methods: Visuospatial analogical reasoning was assessed using Raven's Colored Progressive Matrices (RCPM). Resting-state functional connectivity was evaluated using functional magnetic resonance imaging (fMRI). Empirical covariance matrices and group-sparse inverse covariance (GSIC) matrices were computed from the fMRI data, with the latter negated to estimate partial correlations representing direct connectivity. Correlations between connectivity measures and RCPM scores were analyzed, alongside data-driven clustering to stratify patients.

Results: No significant correlation was found between empirical covariance connectivity and RCPM scores. However, GSIC-based analysis revealed a significant inverse correlation between connectivity of the posteromedial and the left inferior parietal cortex and RCPM scores. Higher parietal connectivity was associated with lower RCPM performance. Patients in the highest connectivity cluster exhibited severe impairments in visuospatial analogical reasoning, particularly in tasks requiring the integration of discrete figures into spatially related wholes. The lesions in these patients were predominantly localized in the left subcortex.

Conclusions: Medio-lateral parietal connectivity may underlie visuospatial analogical reasoning after stroke.

Clinical rehabilitation impact: Clustering analysis highlighted a distinct pattern of low scores in patients with increased parietal connectivity, suggesting that parietal connectivity changes have the potential for characterizing patients with severe dysfunction.

Introduction: Chronic low back pain (CLBP) is a common disabling condition, inflicting a substantial socioeconomic burden. Given its association with neuroplastic changes, as evidenced by central and peripheral sensitization, neuromodulatory techniques such as transcranial direct current stimulation (tDCS) have emerged as potential treatments. This scoping review aimed to identify and map the existing literature on tDCS studies for CLBP to provide insight into how these studies are conducted, and to address their potential gaps in knowledge.

Evidence acquisition: PubMed, Embase, Web of Science, and Cochrane Library were searched for relevant studies from inception to 23 March 2025. Eligible studies included were those examining tDCS alone or with other interventions in adults with CLBP, regardless of the outcome evaluated and included adults with CLBP. The review was conducted using Arksey and O'Malley's six-stage framework and was guided by the PRISMA for scoping review framework.

Evidence synthesis: Of 134 screened records, 26 studies were included: 23 randomized controlled trials and 3 quasi-experimental studies. Half of the studies (50%) had a low risk of bias while one-third (34.6%) showed a high or serious risk of bias. Outcomes evaluated varied and included clinical, biophysical, biomechanical, and psychosocial measures. There was considerable variability in tDCS treatment protocols across studies. The effectiveness of tDCS was inconsistent, particularly for clinical outcomes, with some studies indicating positive effects while others reported no significant effects.

Conclusions: Overall, this review reveals inconsistent results for tDCS effectiveness in CLBP, likely due to variability in study designs, sample characteristics, treatment protocols, and outcome measures. Future well-designed trials are needed to clarify the therapeutic potential of tDCS for CLBP, particularly in combination with other interventions.