Physiotherapy Research International最新文献

Background and purpose: VestAid is a tablet-based computer application designed to deliver vestibulo-ocular reflex (VOR) exercises to persons with dizziness. It was developed to provide objective data to clinicians to drive clinical decisions. VestAid allows for VOR exercise progression between face-to-face visits via telehealth. The primary aim of this study was to determine the consistency of clinical decision-making among physical therapists (PTs) using an exercise performance report (EPR) from the VestAid app and a video recording of patients performing VOR exercises. The secondary aim was to determine the effect of the clinical experience of a vestibular physical therapist on decision-making agreement about exercise choice. Lastly, an attempt was made to determine if the EPR provided adequate information to make a clinical judgment about exercise progression.

Methods: Thirty PTs with varied vestibular experience levels participated. Vestibular experience was clustered into 3 levels [< 5 years of experience (n = 10), 6-15 years of experience (n = 10), and > 15 years of experience (n = 10)]. The PTs viewed 12 videos of individuals with dizziness completing VORx1 exercises that were a priori classified as easy, moderate, or difficult. The PTs were randomly shown 12 EPRs for the same individuals, which included their percentage of gaze fixation, symptom reports, and head speed compliance. Each PT was then asked whether they would progress the exercise program, regress the program, or leave the exercise program unchanged.

Results: Physical therapist percent agreement using the video was 60% compared to 71.1% using the EPR. No differences existed in the percentage of agreement between experience levels. One hundred percent of the PTs with less than 5 years of experience reported that the EPR was sufficient for advancing the exercises, compared with 67% of those with greater experience.

Discussion: VestAid's EPR yielded comparable clinical decision-making agreement to that of the video. The EPR offers PTs insight into gaze fixation and head speed compliance-information otherwise inaccessible without the use of technology. Currently, there are no established guidelines for exercise progression. While such technology shows potential to improve consistency in clinical decision-making, further research is needed to better understand whether objective VOR exercise outcome metrics facilitate recovery.

Background and purpose: Stroke often causes muscle weakness, reduced motor control, and gait abnormalities, such as foot drop and propulsion deficits, which impair weight transfer and walking efficiency. Traditional interventions such as ankle-foot orthoses and botulinum toxin address these impairments but often fail to activate the muscles involved in propulsion. Functional electrical stimulation (FES) has shown potential to enhance muscle activation and gait speed, but its effects on biomechanical parameters, particularly on step-to-step transitions, remain insufficiently explored.

Methods: A randomized crossover design included 18 individuals with stroke who walked with and without functional electrical stimulation (FES). Kinematic data and ground reaction forces (GRF) were recorded to evaluate step-to-step transitions. Outcome measures included the minimum vertical velocity (Vvmin) of the center of mass (CoM) and the force ratio (FRatio) between the back foot (Fback) and front foot (Ffront).

Results: FES significantly reduced the force ratio (FRatio) (p < 0.001), indicating improved force distribution toward the back foot. The minimum vertical velocity (Vvmin) of the center of mass (CoM) occurred earlier with FES (0.470 ± 0.032) compared with No FES (0.513 ± 0.033; p < 0.001), demonstrating enhanced control of CoM redirection during gait.

Discussion: FES applied to specific lower limb muscles improved critical biomechanical gait parameters, including enhanced force distribution and better control of the center of mass (CoM). These findings suggest that FES can optimize gait mechanics, particularly during step-to-step transitions, and improve walking efficiency in individuals with stroke. Further research is needed to assess its long-term effects and explore its integration into rehabilitation protocols.

Trial registration: The study was registered with Clinical Trials.gov (NCT06237972).

Background and purpose: The assessment of physical activity (PA) using Patient-Reported Outcome Measures (PROMs) is routine due to its easy applicability and low cost. In the context of CKD, there are several studies that evaluate PA through PROM, but there is heterogeneity in the choice of tool. Therefore, the objective of this study was to identify, evaluate and synthesize the psychometric properties of PROMs used in the assessment of PA in CKD.

Methods: A systematic review was carried out according to the PRISMA guidelines in PubMed, SciELO, Medline, Lilacs and EMBASE databases. The assessment of the quality of the studies was evaluated using the COSMIN Checklist and EMPRO tool.

Results: 15,137 studies were found, with 17 included. Eleven PROMs were found, of which 2 were elaborate to the CKD population: Chronic Kidney Disease Physical Activity Questionnaire (CKD-PAQ) and Low Physical Activity Questionnaire (LoPAQ). Criterion validity was the most evaluated psychometric property. Only CKD-PAQ shows satisfactory results in both evaluation tools for the psychometric properties evaluated.

Discussion: This systematic review found no consensus in the literature for the best PROM for assessing PA in CKD. However, the CKD-PAQ appears to be promising as the only PROM with a favorable evaluation by both COSMIN RoB and EMPRO. There is a lack of studies evaluating PA in the early stages of CKD and its responsiveness, indicating a gap in the research. COSMIN RoB and EMPRO differed from each other, showing that the choice of the evaluation tool must be guided by the evaluator's expertise and objective.

Trial registration: Systematic review registered in PROSPERO (CRD42022312143).

Background: The term ataxia refers to the inability to coordinate movement. It essentially happens when the cerebellum or any of its connections are damaged. A brain tumor, multiple sclerosis, stroke, cerebral palsy, certain drugs, and genetic illnesses are the few examples of the ailments that can result in ataxia. Although aerobic exercise helps ataxic people in decreasing whole disease severity, conventional training does not significantly aid in this regard. On the other hand, circuit training has also proved effective in reducing ataxic symptoms in some literatures.

Aim and purpose: This study's primary goal was to ascertain whether aerobic or circuit training provides a better course of treatment for the ataxic patients.

Methodology: Eighteen pre-diagnosed ataxic patients participated in a randomized clinical experiment (9 patients in each group) for this objective. Purposive sampling technique was used to collect samples, and patients were allocated into their groups using the lottery method. Group A was aerobic training group and Group B was circuit training group. The time duration for this study was approximately 4 months where data collection took almost 1 month. 30 min sessions consisting of 5 sessions per week were given to the patients for 1 month duration. Data were calculated from Allied hospital. Assessment and examination were carried out using Berg Balance Scale (BBS) and Functional staging for ataxia giving pre- and post-values.

Statistical analysis: Data were analyzed statistically through SPSS 24.

Results: In terms of indicating balance along with ataxia staging, the statistics showed only a slight difference in the aerobic training group than in the circuit training group. The given differences found between the pre and the post values in mean and standard deviation in Group 1 is -11.75 ± 1.48 and in Group 2 is -9.55 ± 3.67. The first treatment group had a mean rank of 9.50 prior to treatment and 7.50 following treatment. Conversely, the mean rank of the second treatment group was 10.33 at the post-treatment level and 9.50 at the pre-treatment level.

Discussion: In essence, these two tactics performed better than some other therapy approaches on a consistent basis. Although there have not been enough studies to compare these two treatments, their respective outcomes are enough to show their effectiveness. Eventually, the aerobic intervention was found only marginally superior to the circuit training, while both were helpful for improving balance in ataxia.

Trial registration: This study used a randomized clinical trial research design. It has been registered in IRCT, that is, the Iranian Registry of Clinical Trials under the registration Id IRCT20240323061354N1.

Background and purpose: The recurrence rate in patients with stroke is high, and arteriosclerosis is a significant risk factor for recurrent strokes. Health literacy, the ability to access, understand, and use information to promote and maintain health, is associated with various health risks. However, its association with atherosclerosis in patients with stroke remains unclear. Therefore, this study aimed to determine whether carotid intima-media wall thickness (CIMT), a marker of atherosclerosis, is associated with health literacy in patients with acute stroke.

Methods: This cross-sectional study included 207 patients (median age: 72 years) after their first stroke, excluding those with subarachnoid hemorrhage, admitted to an acute care hospital. The study variables were CIMT and health literacy. Mean CIMT was measured in the left and right common carotid arteries. Health literacy was assessed using the European Health Literacy Survey Questionnaire (HLS-EU-Q16), a shortened version of the European Health Literacy Survey Questionnaire 47. The correlation between mean CIMT and HLS-EU-Q16 score was analyzed.

Results: Mean CIMT was significantly negatively associated with the HLS-EU-Q16 score (r = -0.174, p = 0.012). Multiple regression analysis identified the HLS-EU-Q16 score as a factor associated with mean CIMT (β = -0.171, B = -0.005, 95% confidence interval: -0.009 to -0.001, p = 0.020).

Discussion: This study demonstrates that health literacy is associated with mean CIMT in patients with acute stroke, with those having low health literacy exhibiting a higher mean CIMT than their counterparts. Therefore, improving health literacy may be an important management strategy to prevent atherosclerosis and its progression in patients with stroke.

Background and purpose: Robotic-assisted therapy for the upper limb (RAT-UL) is a well-established, evidence-based approach to stroke rehabilitation. However, the effectiveness of combining RAT-UL with other therapeutic approaches remains unclear. This systematic review and meta-analysis, registered in PROSPERO (CRD42023422583), aimed to investigate the effect of combination therapy added to RAT-UL compared with RAT-UL alone on improving the motor function, and capacity of the affected upper limb and activity of daily living.

Methods: A systematic search was conducted in PubMed, CINAHL, Physiotherapy Evidence Database (PEDro), and Web of Science. We included randomized controlled trials (RCTs) published in English before October 2024. Methodological quality was assessed using the Cochrane risk of bias tool for RCTs. Meta-analysis was performed using RevMan 5.4 software. The primary inclusion criteria encompassed adults after stroke who underwent combining RAT-UL with other therapeutic approaches.

Results: After reviewing 5669 studies, we included 16 RCTs in this study. The overall effect of combining RAT-UL with other therapeutic approaches on the motor function in Fugl-Meyer Assessment was not significant improvement (MD = 1.40; 95% CI, 0.00-2.81; p = 0.05), whereas the differences on capacity of upper limb in Wolf Motor Function Test-Performance Time (MD = 0.48; 95% CI, 0.01-0.94; p = 0.04) and activities of daily living in the Functional Independence Measure were also observed (MD = 2.21; 95% CI, 0.12-4.31; p = 0.04). However, no significant differences were found in the analysis of activity levels in the ICF domains (SMD = 0.50; 95% CI, -1.33-2.34; p = 0.08). Subgroup analyses showed significant improvements in motor function in the Fugl-Meyer Assessment when partial substitution of RAT-UL with other high-intensity therapeutic approaches (MD = 3.42; 95% CI, 0.61-6.24; p = 0.02).

Discussion: Adding a high-intensity therapeutic approach to RAT-UL may lead to improvement in upper limb function and capacity compared with RAT-UL alone. However, the effectiveness of combining RAT-UL with other therapeutic approaches appears to vary depending on the type of adjunctive therapy employed. The effect sizes were small, and the findings across studies were inconsistent.

Trial registration: PROSPERO (CRD42023422583).

Background and purpose: Research findings on the effects of land-based and water-based exercises on motor performance in people with Parkinson's disease (PD) are conflicting, and despite the known beneficial effects of exercise in these individuals, it is unclear which of these exercise protocols is more beneficial. Therefore, this study aimed to systematically evaluate the effects of exercise on land and water on the performance of people with PD.

Methods: Randomized controlled clinical trials related to the motor performance of people with PD were identified by searching the Science Direct, PubMed, Scopus, and Google Scholar databases and analyzed using CMA v4 software. Of 94 studies based on the inclusion and exclusion criteria, eight English articles were included in the comprehensive review.

Results: The meta-analysis revealed a significant difference in the motor performance of people with PD between the land- and water-based exercise groups (CI 95%, -0.135 to -0.649; MD = -0.392).

Discussion: Water-based exercises may offer greater improvements in motor performance compared to land-based exercises in individuals with PD. Therefore, in addition to conventional exercises, exercising in water could help enhance the motor function of these people, and therapists can incorporate it into their exercise programs.

Background: Pulmonary Hypertension (PH) is a chronic condition that leads to progressive functional limitations, making the assessment of functional capacity essential for clinical management. This study aimed to classify PH patients based on the International Classification of Functioning, Disability, and Health (ICF) qualifiers using the Six-Minute Walk Test (6MWT) and compare this classification with the World Health Organization Functional Classification (WHO-FC).

Methods: This observational study included 33 individuals with PH. Demographic data, pulmonary function, and 6MWT results were collected. Participants were classified according to ICF qualifiers (ranging from no impairment to complete impairment) and WHO-FC. The association between classifications was tested using Fisher's exact test, considering the conceptual differences between them.

Results: Most participants presented moderate functional impairment, with an average 6MWT distance of 431.5 ± 110 m, equivalent to 68% of the predicted value. Based on ICF qualifiers, 39% of patients had mild impairment, 42% moderate, and 18% severe impairment. However, no significant association was found between ICF qualifiers and WHO-FC, reflecting the distinct conceptual frameworks of these classifications. Unlike WHO-FC, which applies fixed cutoffs, the ICF-based classification provides a more individualized assessment by incorporating the contrast between expected and actual performance in the 6MWT.

Discussion: The use of ICF qualifiers enabled a more specific evaluation of functional capacity in PH patients, complementing rather than replacing WHO-FC. This approach allows for a more individualized assessment, supporting targeted rehabilitation strategies and improving clinical decision-making in PH management.

Background and purpose: Mulligan's techniques, such as Sustained Natural Apophyseal Glides (SNAGs) and Natural Apophyseal Glides (NAGs), are commonly applied by physiotherapists when treating patients with non-specific neck pain (NP). However, there has been no comprehensive synthesis of their effects in NP. This review aimed to assess the effectiveness of Mulligan's techniques in reducing pain, improving disability, and enhancing cervical range of motion (CROM) in adults with acute, subacute, or chronic NP.

Methods: A systematic review with meta-analysis was conducted on randomized controlled trials (RCTs) comparing Mulligan's techniques with other interventions in adults with NP. Two reviewers independently conducted study selection, data extraction, and risk of bias (RoB) assessment. Meta-analyses were performed when clinical homogeneity was present; otherwise, a narrative synthesis was used. Certainty of evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach.

Results: Thirty-three studies were included. For acute and mixed (acute/subacute/chronic) NP, Mulligan's techniques were no more effective than other interventions for pain reduction, disability improvement, or CROM enhancement. However, in patients with chronic or uncertain chronicity NP, SNAGs combined with other interventions demonstrated superior outcomes-both statistically and sometimes clinically-compared to certain treatments like exercises and muscle-energy techniques, for reducing pain and disability and improving CROM. The certainty of evidence was rated very low.

Discussion: Mulligan's techniques appear to be safe, simple, and potentially beneficial for managing mixed or chronic NP when combined with other interventions, presenting results that may be comparable or occasionally superior to other standard techniques.

Implications for physiotherapy practice: Physiotherapists may consider incorporating Mulligan's techniques, especially SNAGs, within broader NP treatment strategies, as they offer a feasible, low-risk option for improving patient outcomes, particularly for chronic NP cases when used alongside other therapies.

Background: Diplopia (DP) can have a significant negative impact on one's quality of life, many clinical investigations lend credence to the notion that acupuncture could be used to treat DP symptoms, randomized controlled trials are lacking, and only clinical observational studies have assessed the effectiveness of acupuncture in managing DP.

Purpose: To examine the influence of electro-acupuncture on diplopia in patients with oculomotor and abducens nerve palsy.

Methods: Forty eyes diagnosed with diplopia were randomly classified into study group (A) that received electro acupuncture therapy and standard prophylactic medications for 4 weeks at points selected for treating double vision, and control group (B) who received standard prophylactic medications only. The Hess screen test was used to measure degrees of deviation.

Results: There were statistically significant differences in the post-test (p = 0.38 and 0.003 respectively) in favor of the study group.

Discussion: In conclusion, integration between acupuncture therapies and standard prophylactic medications yields better results in treating DP.