Physiotherapy Research International最新文献

Background and purpose: Chronic low back pain (LBP) significantly impacts quality of life and presents challenges in musculoskeletal health management. Effective sensory integration for balance control is crucial; however, the relationship between fall efficacy and balance strategies in individuals with LBP remains underexplored. This study aimed to evaluate balance strategy scores and equilibrium indices across various Sensory Organization Test (SOT) conditions by comparing individuals with and without chronic LBP in the context of fall efficacy.

Methods: A total of 42 control subjects and 34 subjects with chronic LBP participated in the study. Balance strategy scores and equilibrium indices were assessed across six SOT conditions over three trials. The modified Falls Efficacy Scale (FES) was used to evaluate fall efficacy, incorporating five key outcome measures representing physical, mental, and social functions.

Results: The LBP group exhibited a significant decrease in fall efficacy (t = 2.78, p = 0.01) and demonstrated significant interactions between trials and conditions (F = 25.39, p = 0.001). In SOT Condition 2, the LBP group showed significantly higher strategy scores during the first (t = -2.14, p = 0.01) and second (t = -1.75, p = 0.04) trials, with no significant difference in the third trial (t = 0.16, p = 0.33). Balance strategy scores varied significantly across trials (F = 6.71, p = 0.01).

Discussion: The LBP group's higher strategy scores suggest a predominant reliance on ankle strategies to maintain balance, particularly under conditions with limited visual input during initial trials. This adaptive strategy may enhance fall efficacy by facilitating balance adjustments. These findings provide valuable insights for targeted strategies aimed at improving postural stability in the LBP group. Optimizing proprioceptive feedback and balance confidence is crucial for reducing fall risk and functional limitations.

Background and purpose: Patients with chronic respiratory disease (CRD) often rely on neck muscles for breathing and contribute to poor posture, which alters the length-tension relationship and efficiency of these muscles. Upper body flexibility and good posture can potentiate pulmonary rehabilitation (PR) protocol. The present study aims to evaluate if the addition of upper body flexibility exercises to PR benefits patients in terms of respiratory muscle performance, upper limb endurance, and daily activities.

Methods: The study protocol was approved by the institutional ethical committee before the participant enrollment. Sixty individuals with a diagnosis of chronic respiratory disease were recruited and randomly allocated to a control and experimental group. The control group received a conventional PR protocol, whereas the experimental group received upper body flexibility exercises in addition to PR for 4 weeks. Respiratory muscle performance measured as maximal inspiratory pressure (PImax), upper limb endurance (6-Minute Pegboard and Rings Test), and activities of daily living (Barthel Index-Dyspnea) were assessed at baseline and after 4 weeks for both the groups.

Results: Baseline values were similar for both groups. Group A had scores of 55.1 ± 6.19 for PImax and 372.0 ± 41.80 for the 6-Minute Pegboard and Rings Test, while Group B scored 57.7 ± 6.49 and 394.0 ± 36.99, respectively (p < 0.05), showing greater improvements in Group B. Both groups also showed similar improvements in the Barthel Index-Dyspnea, with Group A scoring 2.61 ± 1.87 and Group B scoring 2.86 ± 1.92 at the end of 4 weeks.

Discussion: The results of the study can be attributed to improved respiratory mechanics, muscle efficiency, and reduced perceived exertion during activities. Hence, respiratory physiotherapists should incorporate upper body flexibility training in PR for better outcomes.

Trial registration: Clinical trial registry India (CTRI/2023/09/057917).

Background and purpose: Diabetic polyneuropathy is associated with poor cognitive performance in executive function, memory and reaction time. Patients had a 50% greater risk of developing dementia. Trans-auricular vagal nerve stimulation (ta-VNS) is a new, safe and promising instrument for enhancing cognitive performance. This study aimed to investigate the effect of trans-auricular vagal nerve stimulation (ta-VNS) on cognitive functions and its impact on quality of life (QOL) in diabetic polyneuropathy patients.

Methods: Forty individuals with type II diabetic polyneuropathy participated in this study. They were randomly assigned to two equal parallel groups: study group (GI) and control group (GII). The study group received active trans-auricular vagal nerve stimulation (ta-VNS) in addition to a computer-based cognitive rehabilitation (CBCR) program, while the control group received the same program with sham (ta-VNS). Both groups underwent intervention three times per week for 3 weeks. Cognitive functions (attention-concentration, and figural memory) and quality of life were assessed at baseline and after 3 weeks using the RehaCom system and the World Health Organization's Quality of Life Brief Questionnaire, respectively.

Results: Post-treatment, there was a significant increase in the level of attention-concentration, as well as a significant increase in the quality-of-life score. Additionally, there was a significant decrease in the mean time for attention-concentration, as well as in figural memory acquisition time for both groups, with more improvement in favor of the study group (p < 0.05). Furthermore, there was a significant increase in the task performance and level of figural memory, along with a significant decrease in figural memory solution time only in the study group (p < 0.05).

Discussions: Adding trans-auricular vagal nerve stimulation (ta-VNS) to Computer-based cognitive rehabilitation (CBCR) program significantly enhancing cognitive functions and quality of life in diabetic polyneuropathy patients.

Trial registration: The study was registered at the ClinicalTrials.gov (NCT06048653).

Background: Resistive squat exercise is a well-established technique to enhance the strength of muscles and bones of the back extensors in humans. Rehabilitation programs aimed at strengthening the muscles and bone of the back require the knowledge of the patient's 1 repetition maximum (RM) of squat exercise. Finding the 1RM value of squat exercise could lead to injury or seem nonfeasible because of the higher weights involved, especially in older adults.

Purpose: To investigate the predictive relationship between the maximum voluntary isometric squat strength and the 1RM concentric and eccentric squat strength in young and older individuals.

Methods: In our cross-sectional study, individuals from two age populations, 21-35 years (young) and 55-75 years (older) were recruited and participated in two visits within a two-week period. Our main outcome measures were: Maximum voluntary isometric squat strength (IsoMax) and 1RM of concentric (ConMax) and eccentric (EccMax) back squat strength were calculated for young and older adults. All the strength measures were normalized for body weight.

Results: IsoMax was a significant predictor of the ConMax (p = 0.003; Normalized ConMax = 0.708 + 1.376(Normalized IsoMax); 95%CI: 0.583-2.169) and EccMax (p = 0.003, Normalized EccMax = 0.844 + 1.433(Normalized IsoMax); 95%CI = 0.582-2.284) in older adults only. There was a trend toward significance for the relationship between IsoMax and ConMax (p = 0.058) in young adults.

Discussion: Our novel findings show that safe techniques for muscle strength assessment, such as maximum voluntary isometric squat strength, can be utilized in older populations to predict their 1RM of concentric and eccentric squat strength. Our novel equations provide the information necessary for designing effective rehabilitation regimes for strengthening the muscles and bone of the back in older adults.

Background and purpose: Stroke is a major cause of disability in adults. Motor recovery through conventional therapy (CT) is a fundamental approach but can sometimes face challenges related to motivation. Virtual reality (VR) rehabilitation, specifically non-immersive VR, is an alternative therapy aimed at improving upper limb motor function and, consequently, functional independence in daily living activities. However, its effectiveness is still being evaluated. Therefore, a meta-analysis was conducted to evaluate the effectiveness of non-immersive VR in upper limb motor function, manual dexterity and the improvement of daily living activities in stroke patients.

Methods: The control groups included physical therapy or occupational therapy. We searched IEEE Digital Library, PubMed, SciELO, Scopus, PEDro, Web of Sciences and ScienceDirect until December 2023 and identified randomized controlled trials (RCTs). Quality and risk were assessed using the revised Cochrane Collaboration tool, PEDro scale, OCEBM, and GRADE. Publication bias and sensitivity analyses were also evaluated. The standardized mean difference (SMD) effect size was calculated to assess the effectiveness of VR therapy compared with conventional therapy. Subgroup analyses were subsequently performed to mitigate the observed heterogeneity and provide further clarity to the results.

Results: In line with previous research, using VR shows improvements in motor function and manual dexterity for stroke patients. Subgroup analyses reveal that the benefits of VR interventions are most pronounced during the acute and subacute recovery stages, particularly in motor function and manual dexterity. Furthermore, combining VR with traditional therapy seems to yield better outcomes in motor function and manual dexterity compared with VR alone. Notably, the type of VR control-whether sensory or manual-or whether the game is commercially available or rehabilitation-specific, does not seem to influence the outcomes. VR interventions lasting less than 4 weeks are effective in improving both motor function and manual dexterity, whereas interventions of 4 weeks or longer only show significant benefits in motor function.

Discussion: These findings highlight the versatility and potential of VR as a complementary tool in neurorehabilitation.

Background and purpose: Verbal instructions and feedback are critical motor learning elements within physiotherapy practice. With evident advantages associated with instructions and feedback that direct learner attention externally, it has been recommended that knowledge about the focus of attention (FOA) be translated into physiotherapy practice. However, most existing information on this topic comes from non-Asian and high-resourced settings. This study aims to fill the knowledge gap regarding context-specific practice patterns by examining the preferences of physiotherapists in the Philippines for external or internal FOA when delivering instructions and feedback across various practice areas. We also explored how professional characteristics relate to these preferences and considerations for delivering instructions and feedback.

Methods: This study employed a cross-sectional survey design. A total of 223 physiotherapists completed an online survey, of which 182 answered questions on their preferences for external or internal FOA based on clinical scenarios. The survey also collected information on participants' professional and practice backgrounds, conscious planning in delivering instructions and feedback, and considerations for varying instructions and feedback.

Results: The participants tended to prefer internal FOA for delivering instructions and feedback, which was not associated with educational background, years of experience, specialisation, geographic region, practice setting, or FOA familiarity. While only approximately half of the respondents were familiar with the concept of FOA, the majority tended to consciously plan the delivery of instructions and feedback based on clients' cognitive and impairment levels.

Discussion: There is an overall preference for internal FOA for delivering instructions and feedback among physiotherapists in the Philippines. Work is needed to enhance practitioners' knowledge of the evidence related to FOA and to facilitate knowledge translation that enables the utilisation of research in physiotherapy practice.

Background and purpose: Participation in regular clinical supervision is recommended for health professionals to ensure quality of care. Effective clinical supervision of physiotherapists typically consists of a one-to-one model using a combination of reflective and direct approaches to supervision. However, this level of support can be difficult to provide in niche clinical specialities such as aquatic physiotherapy, where one expert clinician is tasked with the supervision of many less experienced clinicians. Group supervision is an alternative model which requires fewer resources, but its effectiveness is unknown. This study aimed to explore physiotherapists' perspectives on the effectiveness of a supervisor-led group supervision model in an aquatic physiotherapy service.

Methods: Sixteen physiotherapists at varied career stages who had experienced aquatic physiotherapy group supervision at an inpatient rehabilitation hospital, participated in an interpretive description study using focus groups.

Results: Four themes were identified: skill development, specialised practice area, group interactivity, and structure and processes. The positioning theory and interactivity theory informed the data analysis.

Discussion: Physiotherapists perceived group clinical supervision to be an effective model for clinical skill development in aquatic physiotherapy. They believed that the model was effective because it afforded them time for reflection in a highly specialised and infrequently practised clinical area. Interactivity between colleagues was viewed as the main strength of group supervision. However, they also felt that skill development would be enhanced if the content of the sessions was structured and group supervision was complemented by direct supervision.

Background: A frequent sequela of stroke is upper limb (UL) impairment. Accurate UL function prognosis is crucial for targeted rehabilitation.

Objective: To determine the accuracy of physiotherapists' predictions of UL function and investigate whether prediction accuracy is affected by physiotherapists' seniority within rehabilitation and/or their level of education. Physiotherapist predictions were compared with a prediction algorithm.

Methods: Data from 81 patients were included. Two weeks post-stroke, physiotherapists predicted UL function based on clinical reasoning. ARAT scores (poor, limited, good, or excellent) at 3 months post-stroke served to determine prediction accuracy. Prediction accuracy was calculated as correct classification rate (CCR). Logistic regression was used to explore the effect of seniority and education. McNemar's test was applied to compare physiotherapist predictions to an algorithm applied 2 weeks post-stroke to the same patients.

Results: The overall correct classification rate (CCR) of physiotherapist predictions was 41% (95% CI: 30-51). Predictions were most accurate for the excellent (75%) and poor (71%) categories, but lower for limited (22%) and good (30%). No association was observed between prediction accuracy and physiotherapist seniority or education. There was a tendency, but not a statistically significant superiority, in the prediction accuracy of the algorithm compared to the physiotherapist predictions (Odds ratio 2 [95% CI: 0.96-4.39], McNemar p = 0.0455, exact McNemar p = 0.0652).

Trial registration: Project number: 628213.

Background: Unilateral traumatic trans-femoral amputees exhibit a higher incidence of falling and become physically asymmetrical because the side that was amputated has different feelings and less muscle.

Objectives: To explore the impact of Whole-body vibration Without Visual Feedback (VFDWBV) on postural steadiness in unilateral traumatic trans- femoral amputees.

Methods: A double-blinded randomized controlled study of technology and information was conducted at a modern university. A total of 108 individuals, 40-55 years who had experienced a traumatic amputation of one leg above the knee were divided into three groups: group A received whole body vibration (WBV) with their eyes opened, group B received (VFDWBV), and group C received conservative treatment only. The stability of the prosthetic leg, stability limit, and sway index (m-CTSIB) were assessed at the beginning and after 12 weeks. Sessions occurred three times each week.

Results: Significant statistical differences were seen in the stability of prosthetic legs, the limit of stability, and (m-CTSIB) between groups A and B, considering the treatment interaction (F = 24.8, p = 0.001). Additionally, the group receiving VFDWBV showed a more significant improvement in postural steadiness than those receiving WBV and the control group.

Conclusion: Utilizing VFDWBV at a frequency of 30 HZ can significantly enhance the stability of posture in individuals with unilateral traumatic trans-femoral amputations.

Trial registration: The study was registered with the Clinical Trials.gov (NCT06284733).

Background and purpose: Stroke survivors with type 2 diabetes mellitus (DM) face heightened cardiovascular risks, which are exacerbated by sedentary behaviour (SB). Despite existing interventions, there remains a gap in the literature regarding effective strategies to reduce SB and increase physical activity (PA). The purpose of this study was to explore the feasibility and safety of the 12-week 'Everyday Life is Rehabilitation' (ELiR) intervention comprising recruitment, adherence, practicality, and implementation into everyday life.

Methods: Single-group longitudinal intervention study with 1-week baseline, motivational interviews at weeks 1 and 6, and 12-week follow-up. Stroke survivors with DM (N = 14) were recruited from Neurovascular Center at Zealand University Hospital, Roskilde. The ELiR intervention is a theory-based intervention that focuses on healthcare professionals (HCP) consultations with stroke survivors with DM to address SB and PA. Primary outcomes were recruitment, adherence, completion of physical tests (accelerometer measurements), cognitive tests, and safety. Secondary outcomes were sedentary time and steps collected using an accelerometer and glycated haemoglobin (HbA1c) measurements.

Results: 23 participants were recruited, of whom two were readmitted, one withdrew consent before the baseline test, and six were not discharged with a physiotherapy rehabilitation plan within 1-7 hospitalisation days. The remaining 14 were included and completed the study with a median modified Rankin scale (mRS) score of 1. The ELiR intervention revealed high adherence. Three participants experienced falls, and two were hospitalised. These incidents were not related to the intervention. Future adjustments include modified inclusion criteria, SMS-reminders, and point-of-care HbA1c measurements.

Discussion: The ELiR intervention was feasible and safe. Falls and serious adverse events are in line with previously reported risks. Self-reported questionnaires and clinical tests had low and moderate adherence, whereas accelerometers had high adherence. However, the small sample size limits generalisability, and adjustments to the ELiR intervention are suggested to improve usability in physiotherapy practice before testing in RCT studies to confirm these findings.