Physiotherapy Research International最新文献

Background and purpose: The Timed Up and Go test (TUG) assesses dynamic balance performance. Motion sensors such as gyroscopes have enabled evaluation of the various subtasks of the TUG such as the 180° turn. As fast turning triggers the vestibular system, we hypothesize that the 180° turn is sensitive to change in individuals with unilateral vestibulopathies (UVP). Therefore, the objectives of this study were to formulate the minimal detectable change and minimal clinically important difference (MCID), both anchor- and distribution-based, for the 180° turn time in individuals with UVP.

Methods: In this longitudinal prospective study, data were collected in secondary and tertiary hospitals. Participants were included up to 4 weeks after the onset of the UVP. Unilateral vestibular function loss was confirmed by the criteria of the Bárány society. At baseline and follow-up (10 weeks since onset), participants performed an instrumented version of the TUG and a tandem gait test. An anchor- and distribution-based MCID was calculated for the 180° turn time.

Results: Seventy participants (55 ± 17 years, 35 female) were included. A minimal detectable change of 0.69 s (180° turn time) was calculated. The anchor-, and distribution-based MCID were 0.71 and 0.63 s for the 180° turn time, respectively.

Discussion: In individuals with UVP, an MCID of 0.71 s was observed for the 180° turn time. More research is recommended to confirm our results.

Trial registration: clinicaltrials.gov under ID NCT04979598.

Background and purpose: Diastasis Recti Abdominis (DRA) is a separation of the rectus abdominis muscles which often results from pregnancy. This meta-analysis aims to identify the most effective non-surgical treatment to reduce post-partum DRA.

Methods: A comprehensive search was performed on electronic databases including PubMed, Cochrane, and Embase databases for RCTs involving abdominal or pelvic muscle exercises, and abdominal binding for DRA Reduction. Primary outcomes included inter-recti distance (IRD) Resolution, Oswestry Disability Index (ODI) score, and Pelvic Floor Disability Index (PFDI) score. ROB 2.0 tool was used for the risk of bias assessment of RCTs. Meta-analysis was performed using Review Manager version 5.4. Sensitivity analysis was conducted to determine the influence of studies on the overall results. Meta regression was performed using R version 4.4 to identify the sources of heterogeneity.

Results: Thirteen RCTs were included in the analysis. Abdominal exercise significantly reduced IRD below the umbilicus compared with abdominal binding (Mean difference [MD] = -0.31, 95% CI: -0.53 to -0.10, p = 0.004) but was ineffective for IRD resolution ≥ 2 cm above the umbilicus (MD = 0.22, 95% CI: -1.43 to 1.88, p = 0.79). Compared with no intervention, abdominal exercise significantly reduced IRD below the umbilicus (MD = -0.31, 95% CI: -0.53 to -0.10, p = 0.004) but was ineffective in IRD resolution ≥ 2 cm above the umbilicus (MD = 0.11, 95% CI: -0.38 to 0.59, p = 0.67). No significant reduction was found in the ODI score (MD = -5.57, 95% CI: -19.31 to 8.17, p = 0.43) and PFDI score (MD = -12.99, 95% CI: -43.49 to 17.51, p = 0.04).

Discussion: Abdominal exercises reduce IRD below the umbilicus more effectively than binding and no intervention, but their effectiveness above the umbilicus is unclear. ODI and PFDI showed no significant improvement. Further research with standardized criteria and diverse population is needed to clarify the efficacy of these treatments for diastasis recti.

Background and purpose: Cardiac surgery enhances cardiovascular disease (CVD) patient survival rates, and the fast-track protocol can reduce complications, hospital length of stay (HLOS) and associated costs. However, there is no evidence on the effectiveness of unsupervised physiotherapy programmes in reducing HLOS and postoperative pulmonary complications in patients undergoing fast-track surgery. The study aimed to determine if a pre-surgical respiratory programme reduces intensive care unit length of stay (ICULOS) and HLOS patients undergoing fast-track surgery, and its effects on post-operative complications and healthcare costs.

Methods: This was a retrospective observational cohort study. The patients were divided into two groups: those who followed the exercise programme (pre-hab group) and those who did not (no pre-hab group). The study analysed the mean of ICULOS and HLOS for each group, recorded post-operative complications, and calculated healthcare costs using the Spanish Ministry of Health cost tables.

Results: A total of 418 patients participated in the study with a mean age of 70.44 (10.87) years. The study found significant differences in HLOS (p = 0.001) and ICULOS (p = 0.003) between groups. Pre-hab HLOS was 232.8 (221.3) hours in the hospital, whereas no pre-hab LOS increased to 315.1 (277.9) hours. Pre-hab ICULOS was 82.0 (129.8) hours when No pre-hab ICULOS accounted 120.2 (190.3) hours. This reduction in hospital admissions resulted in savings of €356,107.16 in average healthcare costs for the pre-hab group. Mortality risk (p = 0.034) was also reduced in the pre-hab group (17.7% vs. 26.65% in the no pre-hab group).

Discussion: An unsupervised home-based respiratory programme reduces hospital and ICU stay, healthcare costs, post-surgical pulmonary complications, and mortality risk. The clinical application of an unsupervised home-based pre-habilitation programme, focussing on ventilatory exercises and costal expansion techniques, has proven effective in enhancing patient recovery post-cardiac surgery, offering significant healthcare cost savings, and reducing the burden on hospital resources.

Background and purpose: As sprinting gains popularity, enhancing anaerobic capacity, neuromuscular function, and cognitive performance is crucial. This study evaluated the effects of Total Motion Release (TMR) and caffeine on these functions in male sprinters to optimize performance strategies.

Methods: In this randomized controlled trial, 56 male sprinters were randomly assigned to control, caffeine, TMR, or caffeine plus TMR groups. The Stroop test, Eriksen flanker task, FMS, and Wingate test were used pre- and post-intervention, with effects analyzed via within- and between-group comparisons.

Results: Flanker congruent and incongruent reaction times significantly decreased with caffeine, TMR, or the combination of both (p < 0.05), with caffeine showing the greatest effect on congruent reaction times (p < 0.05). All groups except the control improved their FMS scores, but no group was significantly superior. Peak, average, and relative peak power increased in all groups except the caffeine group (p > 0.05), with no group outperforming the others. Heart rate showed a slight increase in the group receiving both caffeine and TMR (p < 0.05).

Discussion: Caffeine increases cognitive function, while TMR boosts accuracy, power, and neuromuscular function. Combined, they improve cognitive performance and reduce reaction times. TMR improves anaerobic capacity; caffeine has minimal impact. Caffeine may be better for those without sensitivity, while TMR can support neuromuscular readiness, power, and accuracy. TMR is recommended, especially for high-acceleration sports.

Trial registration: The study was registered with the IRCT committee (No: IRCT20230708058720N1, March 13, 2024).

Background and purpose: Trigger points can disrupt muscle activity patterns and cause cramping, fatigue, and weakening. Massage guns and myofascial release are widely employed for such circumstances, but their isolated outcomes are unknown. This study aimed to compare the effectiveness of a massage gun versus myofascial release technique on subjective pain, pain pressure threshold and ankle ROM for 12 weeks in people with pain and latent trigger points in the calf muscles.

Methods: From December 2024 to November 2025, this assessor-blinded randomized clinical trial will enroll 60 patients with latent myofascial trigger points in the calf and equally (1:1) allocate them randomly to either massage gun (Group A) or myofascial release technique (Group B) at the Outpatient Service Unit, Department of Physiotherapy and Rehabilitation, Jashore University of Science and Technology (JUST), Jashore, Bangladesh. Both groups will receive 12 sessions of massage gun or myofascial release on latent trigger points, with 20 min of ice once a week for 12 weeks. The primary outcomes are subjective pain severity by the visual analog scale and pain sensitivity by pressure algometry, while the secondary outcome is ankle dorsiflexion range of motion by an inclinometer to be measured at the baseline and 12 weeks post-treatment. The ethical approval and trial registration obtained prospectively, we will adhere to the International committee on harmonization good clinical practice (ICH-GCP) by confirming confidentiality, respect, voluntary participation and withdrawal rights of participants and justice. To ensure trial safety, the manageable and fatal adverse effects will be recorded and reported.

Results: Sociodemographic, clinical, and outcome characteristics will be collected at baseline after randomization. A non-experimental assessor will evaluate group treatments afterward. A data monitoring committee-appointed expert data analyst will compare and analyze the independent assessors' baseline and post-treatment outcome values.

Discussion: This study will address the research gap on isolated outcomes of newly addressed widely used massage guns and conventional myofascial release techniques on reducing subjective pain, and pressure pain threshold and improving ankle ROM for patients with pain and latent trigger points at the calf muscle. This single-centre study will indicate short-term outcomes with poor external generalization, but the study will help the clinicians in evidence-based practice and guide future multicenter studies with long term evaluations with a follow-up design.

Trial registration: Clinical Trial Registry of India (CTRI) (XXXXXXXXXXX) (Prospectively registered).

Background and purpose: TAR method recommends reorganizing ventilatory muscle synergism, reducing respiratory effort, removing secretions from the lungs and upper airways, in addition to promoting diaphragmatic juxtaposition and increasing respiratory muscle strength and adjusting muscle tone. However, there are few scientific publications on this method in cardiac patients CABG. To evaluate the effects of the TAR method on hemodynamic variables, respiratory distress and pulmonary complications in patients after CABG surgery.

Methods: This is a single-blind, randomized, clinical trial. Adults (> 35 years old), hemodynamically stable, who had undergone CABG (< 24 h) and with a prescription for physiotherapy were included. Patients were randomized into two groups: IG - TAR; CG-standard physiotherapeutic approach. Interventions were carried out in two days (twice/day), totaling 04 sessions. The following parameters were evaluated pre- and post-intervention: HR, RR, SpO2, MAP, respiratory distress scale. The pulmonary complications scale was applied at the end of the interventions. The sample consisted of 58 patients, 30 in the CG and 28 in the IG.

Results: There was no significant difference (p < 0.05) in sample characteristics, clinical and perioperative data between groups. There was a significant increase (p < 0.05) in RR and MAP after the intervention in CG and IG. Only in GI there was a significant reduction in the respiratory distress score (p = 0.001). Furthermore, there was a lower score (p < 0.0001) on the scale of pulmonary complications at the end of the interventions in the IG group, compared to the CG.

Discussion: The TAR method reduced respiratory distress and pulmonary complications in patients after CABG surgery. Given our findings, it becomes feasible to aim for the applicability of the method in other populations, expanding it to other elective or non-elective surgical conditions, in oncology, traumatology, and neurology, making the recovery process more effective.

Keywords: Physiotherapy; Cardiology; Thoracic-abdominal rebalancing.

Trial registration: NTC 04631198.

Background and purpose: Patient education on physical activity (PA) requires a clear understanding of PA intensity. However, there is no organized list of PAs intensities specific to individuals with stroke. This review aimed to clarify the intensity of PAs in people with stroke and summarize the methodologies and participant characteristics in previous investigations of energy expenditure (EE) during PAs.

Methods: A systematic search was conducted using PubMed, CINAHL, the Cochrane Library, and PEDro databases in October 2021, and repeated in February 2024. Reports meeting the eligibility criteria were reviewed to extract participant characteristics and summarized EE for each PA type according to gait ability. Where possible, EE during PA was integrated using a weighted mean.

Results: A total of 55 eligible articles and 1719 participants were included. Twenty-one PAs were identified, most of which involved walking or exercise. Data on acute stroke were sparse, accounting for only 1.2% of all participants. PAs related to daily living were typically measured over 5-8 min, with steady-state means used for movement tasks. Among ambulatory patients, walking with maximal effort corresponded to moderate-to-vigorous PA (> 3 METs), even at low speeds. However, comfortable walking at slow speeds, sit-to-stand, and reaching while standing corresponded to light PA (1.6-2.9 METs).

Discussion: EE during PA in people with stroke has been inadequately investigated, particularly for daily activities other than walking, and studies involving acute stroke remain limited. Additionally, EE during light PAs, such as reaching, sit-to-stand, wheelchair propulsion, and comfortable walking at slow speed in ambulatory stroke patients, was found to align closely with values reported in the Compendium of PAs.

Trial registration: PROSPERO, CRD42022300366.

Background and purpose: Incorporating Person-centred Care (PCC) and Comprehensive Geriatric Assessment (CGA) practices for hospitalised patients result in positive health outcomes. We aimed to identify the frequency of incorporating PCC and CGA practices among physiotherapists (PTs) working in hospitals and its association with PTs' gender, years of experience, and duration of physiotherapy sessions and to identify the barriers to assessing older patients in the hospital.

Methods: Cross-sectional survey with physiotherapists working in hospitals using a questionnaire including PTs characteristics, barriers and the frequency of incorporation of PCC and CGA practices, using a Likert scale. An ordinal regression analysis was conducted.

Results: Male PTs, compared to females, were less likely to consider the patient's and family's feelings (OR = 0.35; p = < 0.001), use appropriate language (OR = 0.42; p = 0.04), embrace the patient's feelings (OR = 0.28; p = < 0.001), adapts their communication (OR = 0.33; p = 0.006) and used encouragement and negotiation strategies (OR = 0.52; p = 0.02). Less experienced PTs (< 2 years) tended not to value older patients' choices (OR = 0.08; p = 0.03), share assessments with families (OR = 0.39; p < 0.001), define a care plan (OR = 0.61; p = 0.02), and embrace the patient's feelings, compared to more experienced ones. PTs conducting quick assessments (< 10 min) were less likely to provide feedback (OR = 0.26; p = 0.006), share assessments with families (OR = 0.09; p < 0.001), define a care plan (OR = 0.22; p < 0.001), assess social conditions (OR = 0.34; p = 0.009), falls (OR = 0.06; p = 0.007), sarcopenia (OR = 0.18; p = 0.002), frailty (OR = 0.27; p = 0.006), provide prognosis (OR = 0.29; p = 0.002), consider older patients' goals (OR = 0.21; p = 0.04) and plan discharge (OR = 0.23; p < 0.001). The main barriers were related to patients' health conditions and the limitations of time and resources.

Discussion: Incorporating PCC and CGA practices by PTs in the hospital seems to be linked to the characteristics of PTs and their availability of time. Educational and organizational interventions to foster PCC and CGA are needed.

Background and purpose: Assisted Autogenic Drainage (AAD) is suggested as a promising technique for effective secretion removal, especially in non-cooperative patients, including infants. However, there is a scarcity regarding the effects of AAD on diaphragmatic function. This study aimed to evaluate the immediate effect of the AAD technique on diaphragmatic function in a healthy infant.

Methods: Case Presentation-This exploratory case study involved a healthy 1-year-and-2-month-old female infant. CARE case reporting guidelines were followed. After collecting demographic data, the AAD technique was applied for 5 min using an abdominal belt. Diaphragmatic function, including excursion (DE) and contraction velocity (CV), was assessed via ultrasonography before and after the intervention.

Results: Post-intervention, significant increases in inspiratory DE (12.08-18.57 mm), expiratory DE (9.28-16.33 mm), and CV (17.14 to 27.65 mm/s) were noted, indicating that AAD positively impacts diaphragmatic function. These results reflect a notable improvement in diaphragmatic mobility.

Discussion: With regard to the potential mechanism, the increased diaphragmatic excursion observed may be attributed to a temporary enhancement of thoracoabdominal synchrony. The abdominal belt utilized during the intervention likely provided stability to the abdominal muscles and the zone of apposition of the diaphragm. Further studies are needed to investigate how long these effects persist.