Physiotherapy Research International最新文献

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.

Background and purpose: Knee osteoarthritis (KOA) is associated with early muscular alterations and muscle weakness, which contribute to disease progression. However, limited knowledge exists regarding the potential exacerbation of lower extremity muscle architecture and its impact on functional performance. This study aimed to investigate the relationship between knee extensor and ankle plantar flexor muscle architecture, femoral cartilage thickness, age, body mass index (BMI), pain severity, and functional performance in middle-aged women with KOA.

Methods: A total of 87 patients diagnosed with KOA (mean age = 51.48 ± 4.89 years, mean BMI = 27.96 ± 4.66 kg/m²) were included in the study. Ultrasonography was used to assess muscle thickness, adipose tissue thickness, pennation angle, and the muscle/adipose tissue thickness ratio (MATR) of the Rectus Femoris (RF), Vastus Medialis (VM), Vastus Lateralis (VL), and Medial Gastrocnemius (MG) muscles. Physical performance was evaluated through the stair-climbing test and the 10-time sit to stand test. Pearson's correlation test and multiple linear regression analysis were used.

Results: The pennation angle of the VL and pain level predicted sit to stand test results; the pennation angle of RF, age, BMI and pain level predicted stair-climbing test results (p < 0.001). Femoral cartilage thickness at the medial condyle, intercondylar area, and lateral condyle correlated with performance in both tests (p < 0.001). Additionally, age, BMI, pain intensity, muscle thickness, pennation angle and MATR of RF, VL, and VM correlated with both functional tests (p < 0.05).

Discussion: Muscle architecture alterations correlated with functional test results in patients with KOA. Understanding the influence of muscle architecture on functional parameters can facilitate the development of effective rehabilitation strategies to preserve and optimize patient function before it becomes compromised.

Trial registration: Enrolled in clinical trials and awaiting approval.

Background: Up to 66% of stroke survivors develop a fear of falling (FoF) which has profound detrimental quality-of-life effects. Gender-based patterns influence FoF, and cross-cultural differences exist, especially in cultures with differing norms for men and women. Studies exploring the interaction between gender and post-stroke FoF are lacking, including in Saudi Arabia, which differs in potentially important gender-based related cultural norms.

Purpose: The aim of this study was to explore the relationship between FoF in Saudi men and women who survived a stroke, and identify clinical predictors of FoF in these populations.

Methods: This cross-sectional study included 80 stroke patients (mean age = 63.9 years; 40 women). We used the Fall Efficacy Scale International (FES-I) to measure FoF, and collected clinical outcome measures to capture motor, affective, and cognitive functioning. For statistical analysis, we used Spearman rho correlation and stepwise multiple linear regression analysis with statistical significance set at p < 0.05.

Results: Balance confidence and cognitive function were significant predictors of FoF (R² = 0.65; p < 0.001). In women, FES-I scores significantly correlated with all of the motor outcome measurements conducted. In contrast, in men, FES-I scores significantly correlated with all of the affective outcome measurements conducted as well as with some of the motor outcome measures (p < 0.05).

Discussion: Affective and cognitive functions are predictors of FoF in stroke survivors, but the association of FoF with clinical factors differs in Saudi men and women.

Introduction: Mechanical ventilation (MV) is a crucial intervention for patients with respiratory failure to ensure optimal gas exchange. However, there is strong evidence that MV exerts significant structural and functional alterations on the diaphragm, leading to a notable decline in its contractile force and the consequent atrophy of its muscle fibers. This condition, referred to as ventilator-induced diaphragmatic dysfunction (VIDD), is an integral factor contributing to challenges in weaning patients off MV, a reduction in their quality of life, and escalated Mortality Risks.

Objectives: This review highlights the complications of MV, with a focus on VIDD and its clinical implications. It explores bedside diagnostic tools for VIDD and examines exercise-based interventions aimed at preventing or reversing daiphragmatic weakness.

Discussion: Rehabilitation programs, including early mobilization and inspiratory muscle training (IMT) for critically ill patients, have the potential to prevent or mitigate the adverse effects of prolonged Mechanical ventilator and improve clinical outcomes. Numerous studies have demonstrated that these interventions are both safe and feasible, offering benefits such as enhanced physical functioning, reduced duration of mechanical ventilation, and shorter stays in intensive care and hospital settings. However, despite these demonstrated advantages, the implementation of rehabilitation programs remains infrequent in routine clinical practice, often hindered by various perceived barriers.

Conclusion: Recognizing and addressing respiratory muscle weakness is crucial, as it represents a reversible and treatable factor that can significantly improve patient outcomes.

Background: Chronic Plantar Fasciitis (CPF) is commonly associated with elevated levels of anxiety and pain catastrophizing. Pain Neuroscience Education (PNE) has shown promise in addressing these psychological components, but high-quality evidence assessing its combined impact with physiotherapy for CPF is limited.

Purpose: This study evaluates the potential benefits of incorporating Pain Neuroscience Education alongside Physiotherapy for managing Chronic Plantar Fasciitis.

Methods: A randomized controlled trial will recruit 160 participants between the ages of 18 and 44, all diagnosed with Chronic Plantar Fasciitis (CPF). Participants will be randomly and equally divided into two groups: a conventional physiotherapy group undergoing 45-min sessions of standard physiotherapy, and an experimental group receiving the same physiotherapy regimen supplemented with a weekly 15-min Pain Neuroscience Education (PNE) session. The outcome measures will include the Numeric Rating Scale (NRS) for assessing morning first-step pain, the Foot Function Index (FFI) for evaluating foot and ankle function, the Pain Catastrophizing Scale (PCS) for measuring catastrophic thinking, the Tampa Scale for Kinesiophobia (TSK) for fear of movement, and the Y-Balance Test for dynamic balance assessment. Data will be collected at baseline, after 3 weeks, and at 6 weeks.

Results: Data normality will be checked using the Kolmogorov-Smirnov test. Depending on the data distribution, between-group differences will be analyzed using either the independent t-test or Mann-Whitney U test, and within-group changes will be assessed using the paired t-test or Wilcoxon signed-rank test.

Discussion: The findings of this trial are expected to shed light on the additional benefits of integrating Pain Neuroscience Education with conventional physiotherapy in the management of Chronic Plantar Fasciitis.

Trial registration: This study was registered with the CTRI registry. The trial number is CTRI/2024/03/064616.

Background: The morbidity and death rates from burn injuries in children are considerably raised by lung issues resulting from inhalation injuries.

Purpose: The purpose of this study was to ascertain how Wii aerobic exercise affected children who had inhaled injuries following thermal burns.

Methods: Children with inhalation injuries (N = 76) were split into two equal groups for this randomized controlled experiment. One group received conventional chest medical treatment along with Wii aerobic exercise. The control group, on the other hand, merely received routine chest medical treatment. Over 3 months, each patient underwent pulmonary function testing, chest expansion, the six-minute walk test, and the timed up-and-go evaluation.

Results: There was no statistically significant difference between the two groups at baseline assessment, but after 12 weeks of treatment, there was a treatment effect (p = 0.001 and f-value = 24.25). In the Wii aerobic group, there was a notable interaction between treatment and time, namely between pre-and post-treatment, while the control group did not show any such difference.

Conclusions: Pulmonary function tests, chest expansion, the six-minute walk test, and the time-up-and-go test are all positively impacted by Wii aerobic training.

Study registration: The study was registered with the Clinical Trials.gov (NCT06326593).

Background: Non-specific neck pain (NSNP) is a significant health issue for individuals in occupations requiring extensive use of electronic devices. Kinesiology taping (KT) and self-cervical sustained natural apohyseal glides (SNAGs) are potential techniques for managing NSNP. However, the existing literature lacks consensus on their effectiveness. The aim of the study was to compare the effectiveness of KT and self-SNAGs applied to the cervical region of long-duration electronic device (LDED) users.

Methods: The study was a single-blinded, two-arm, and parallel randomized controlled trial approach. LDED users who had symptoms of pain in the cervical region were randomly allocated to either the KT (n = 15) or self-SNAGs (n = 15) group. Outcomes included upper trapezius (UT) muscle activity, Visual Analog Scale (VAS), joint position sense error (JPSE), and respiratory muscle strength. Participants were evaluated at baseline, 4 weeks post-intervention and at a 1-month follow-up.

Results: There was statistical significance in UT muscle activity, VAS, and JPSE after the 4 weeks period of treatment within the groups. There was statistical significance in respiratory muscle strength only in the group that received self-SNAGs (p = 0.032). There was no statistical difference between the two groups after treatment in all outcomes apart from JPSE during extension (p = 0.028). Group by time interactions showed no statistical significance across the three timelines between groups.

Discussion: KT and self-SNAGs have desirable effects on pain intensity, proprioceptive sense, and upper trapezius muscle activity among LDED users with symptoms of NSNP. However, self-SNAGs were more effective in improving respiratory muscle strength than KT.

Background and purpose: Exercise is commonly prescribed for patients with low back pain (LBP) and maladaptive changes in lateral abdominal muscle (LAM) activation. The literature has considered various exercise programs, but the evidence has not consistently identified exercise parameters associated with superior outcomes. The aim of this study was to determine how physiotherapists should prescribe exercise for patients with persistent LBP who present with maladaptive LAM activation.

Methods: This was a three round Delphi survey. The international expert panel comprised physiotherapy clinicians with postgraduate orthopaedic manipulative physiotherapy training. Round 1 included open ended questions. Responses were collated and coded using content analysis. In Rounds 2 and 3, participants were provided with the collated responses and rated their agreement with or chose their preferred options regarding exercise prescription for patients with maladaptive LAM activation. Items were defined as meeting consensus when ≥ 70% of participants agreed/disagreed or chose the same option.

Results: Twenty-three physiotherapists consented to participate. Seventeen, 20 and 15 participants completed Rounds 1, 2 and 3, respectively. The exercise prescription suggestions consisted of 46 items reaching consensus across the domains of exercise: goals, considerations, agreement on prescribing exercise for the LAM and other muscles, muscle activation during exercise, the exercise prescription and its focus.

Discussion: This study provides clinically informed recommendations for physiotherapists prescribing exercise for patients with persistent LBP and maladaptive LAM activation. Findings align with motor control exercise approaches outlined in the literature. Participants emphasised the consideration of patient preferences and balancing motor control exercise with moderate/vigorous physical activity.

Objective: To investigate the key factors that influence patients' preferences for telerehabilitation consultations in comparison to traditional in-person physiotherapy consultations and explore how these factors vary across different patient demographic characteristics.

Methods: A binary discrete choice experiment was conducted with 152 participants who had participated in physiotherapy. The primary outcome measures were the attributes related to telerehabilitation and in-person consultations, including appointment duration, cost, distance, purpose, therapist, time of day, and wait time. Participants' preferences were assessed based on their choices in the binary choice experiment.

Results: The study did not identify any attributes of consultations that clearly influenced patients' preference for telerehabilitation versus in-person physiotherapy. There was a trend towards preferring telerehabilitation with decreased appointment wait times and lower monetary costs. Patient demographics revealed that individuals with a single chronic health condition were clearly less inclined towards telerehabilitation (OR = 0.5, 95% CI 0.27-0.93), as were those located in outer regional locations (OR = 0.34, 95% CI 0.12-0.99). Additionally, respondents preferring a short 5 km travel distance showed markedly lower preference for telerehabilitation (β_{Telerehab×Distance_5km} = -0.94, 95% CI -4.34 to -0.51, p < 0.001).

Conclusion: To enable broader access to physiotherapy via telerehabilitation, clinicians, and policymakers should prioritize offering timely and cost-effective sessions. The results of this study can then inform the development of telerehabilitation offerings that are better matched to patient preferences.

Background and purpose: The education of physiotherapists is disengaged from social control, which is one of the principles of the Brazilian public healthcare system. Social control ensures the participation of the population in the planning and monitoring of the public healthcare system and depends on qualified professionals. Thus, the aim of the present study was to investigate how training in social control occurs in undergraduate physiotherapy courses at public higher education institutions in the state of São Paulo, Brazil.

Methods: Five teaching staff members were interviewed and six teaching projects were analyzed from a total sample of six public higher education institutions in the state of São Paulo using a qualitative method.

Results: The physiotherapy curriculum at Brazilian higher education institutions is based on the national curricular guidelines. However, these guidelines have gaps in the curricular guidance related to social control in terms of ensuring consistent training throughout the course, practical experiences, and a sufficient workload. To overcome barriers to training in social control, there is a need for the qualification of teaching staff, the adoption of skill-based education, the strengthening of social control, and a human resource policy favoring the hiring of physiotherapists in the Brazilian public healthcare system.

Discussion: Training in social control in physiotherapy courses at higher education institutions remains a challenge, considering the complex skills involved and the requirement of curricular changes. The present study only analyzed public educational institutions in the state of São Paulo, Brazil.