Physiotherapy Research International最新文献

Background and purpose: Heart failure (HF) is a complex syndrome that impacts persons' daily activities and adherence to exercise programs. Non-Invasive ventilation (NIV) reduces respiratory load and improves cardiac function, potentially serving as an important adjunct in its treatment. These effects can be enhanced with a cardiac rehabilitation program, improving dyspnea and functionality. This study aimed to evaluate the effects of NIV during exercise on functional performance outcomes, dyspnea, QL, hemodynamics, and respiratory function.

Methods: A systematic review followed by meta-analysis was conducted. Searches were performed in PubMed, CENTRAL, Embase, LILACS, SciELO, and CINAHL.

Eligibility criteria: Randomized clinical trials of patients over 18 years of age with HF, compared to a control group, were included with the objective of improving exercise tolerance. The studies were categorized as short-term effects of NIV and those implementing an exercise program.

Results: Seven studies were included in the qualitative review and five in the meta-analysis. Only two studies presented a low risk of bias. The analyzed outcomes were the 6-min walk test (6MWT), dyspnea, SpO2, heart rate (HR), systolic, and diastolic arterial pressure (SAP and DAP, respectively), maximal inspiratory and expiratory muscle strength (MIP and MEP, respectively), forced expiratory volume in one second (FEV1), and quality of life (QL).

Discussion: There was a significant difference in favor of the NIV group compared to the control group in both modalities in relation to the 6MWT, with a mean difference (MD) 41.72 (CI 95% 2.15, 81.29) meters in the exercise program and MD 68.61 (CI 95% 5.69, 131.54) meters in short-term effect studies. There were also favorable results in the outcomes of dyspnea and FEV1 in the NIV group (p < 0.01). There were no statistically significant differences in the outcomes peripheral oxygen saturation (p = 0.11), systolic (p = 0.76) and diastolic blood pressure (p = 0.93), heart rate (p = 0.19), MIP (p = 0.49), MEP (p = 0.22) and QL (p = 0.13).

Trail registration: PROSPERO CRD42022367746.

Background: Stroke often leads to long-term disability, impacting motor function, mobility, and quality of life. However, the effectiveness of different intensities of functional training in improving these outcomes in stroke rehabilitation is not well established.

Purpose: This study aimed to determine the effects of different intensities of functional activities specific training on upper extremity function, mobility, fall risk, and quality of life in stroke patients.

Methods: This randomized controlled trial was conducted in a rehabilitation setting (PRH Islamabad) with age 40-60 years and 3 months post-stroke. Participants (N = 99) were randomly (simple) assigned to conventional therapy, moderate-intensity, or high-intensity training with 33 in each group. Eligibility criteria included a Montreal Cognitive Assessment score of 18-25, Fugl-Meyer Assessment score of 50-70 and a Modified Rankin Scale score of 3 and 4, suggesting moderate motor impairment and moderate to severe disability, respectively. Participants with severe spasticity, inability to follow two-step commands, concurrent stroke treatments, other neurological conditions, and a history of falls were excluded. The 12-week training program utilized the FAST-Table, and outcomes including Fugl-Meyer Assessment for upper extremity, Berg Balance Scale, and Stroke-Specific Quality of Life Urdu scale-were assessed at baseline, 4, 8, and 12 weeks.

Results: The mean age of participants were 65.4 ± 7.2 years, gender (52% male, 48% female, ischemic 70%, and hemorrhagic 30%). The high-intensity group showed significant improvements in Fugl-Meyer Assessment-Upper Extremity scores at weeks 8 and 12 (p < 0.05), Timed Up and Go test (p < 0.05), Berg Balance Scale scores (p < 0.05), and Stroke-Specific Quality of Life Urdu scale (p < 0.05). Moderate-intensity and conventional groups also showed improvements individually.

Discussion: High-intensity functional training leads to greater improvements in physical performance and quality of life in stroke survivors compared with moderate-intensity functional training and conventional therapies.

Trial registration: https://clinicaltrials.gov/ (NCT05158543).

Background: Improving hand and arm function is an important goal for individuals with cervical spinal cord injury (cSCI). Activity Based Therapy (ABT) is a neurorestorative approach that incorporates a high intensity, long duration and effortful engagement to garner sensory-motor improvements. Spinal cord stimulation is a neuromodulation modality that can restore sensory-motor function. Spinal cord stimulation can elevate the excitability of the spinal neural network and potentially enhance the neurorestorative benefits of ABT. However, there is scarce evidence on the combined effects of ABT and spinal cord stimulation on UL recovery after cSCI.

Objective: This report aims to describe how theory informed the design and development of a Phase 1 study on a new UL intervention combining ABT and transcutaneous cervical spinal cord stimulation (tCSCS) (short form:ABT-tCSCS) delivered simultaneously for individuals with cSCI.

Method: The design of the ABT-tCSCS was guided by theory-based frameworks such as the Rehabilitation treatment specification system and the Template for Intervention Description and Replication guide. The ABT-TCSCS aimed to improve somatosensory-motor deficits and function in the UL after cSCI. The ABT-tCSCS intervention was developed through the following stages: (a) Description of the active ingredients, mechanism of action, and targets of the ABT-tCSCS; (b) Tailoring of ABT-tCSCS; and (c) Development of treatment regimen guidelines for the delivery of the ABT-tCSCS.

Results: ABT constitutes 4 types of exercises, including cardio-fitness, resistance, postural/weightbearing, and functional exercises, for activation of the neuromuscular system below the level of lesion to target somatosensory-motor impairments. In tCSCS, electrical stimulation is delivered at a frequency of 30-50 Hz at 500-1000 μs between C3-C7. The spinal neural networks of the cervical region are stimulated to neuromodulate the descending motor commands which control the muscles. ABT-tCSCS will be delivered simultaneously over 28 sessions (1 h/session, 3x/week over 9-10 weeks).

Conclusions: Combined ABT-tCSCS is a new intervention for neurorestoration of the upper limbs after cSCI.

Trail registration: ClinicalTrials.gov ID: NCT06472986.

Background: Sexual function is commonly affected post stroke and impacts an individual's quality of life. This study aimed to determine the factors associated with sexual function in an individual post stroke and the association with quality of life.

Method: This cross-sectional study included 56 participants who had a stroke between three and 24 months prior. The participants were assessed for: level of disability with the Modified Rankin Scale (MRS); quality of life with the Stroke Specific Quality of Life scale (SSQOL); and sexual function with the Changes in Sexual Functioning Questionnaire (CSFQ-14), and an open-ended questionnaire was administered.

Results: The average age of the participants was 51.32 (SD = ±13.24) years, with 32 (57.1%) males and 24 (42.9%) females. According to the CSFQ-14, the majority of the study participants (n = 35, 62.5%) had sexual dysfunction after their stroke. The factors associated with sexual dysfunction post stroke included age, disability, comorbidities, psychosocial factors such as self-esteem, role changes, and depression. Those with sexual dysfunction were found to have a lower mean SSQOL score (139.94 ± 33.89) than those without sexual dysfunction (149.76 ± 33.77), however, there was no significant difference (p = 0.298) between the groups. Majority of the participants (n = 37; 66.1%) did not know that healthcare professionals can assist with sexual dysfunction.

Conclusion: The majority of participants experienced sexual dysfunction after their stroke. Factors such as pain, difficulty with positioning, self-esteem issues, lack of motivation, and change in desire, are important considerations for the multidisciplinary team in the rehabilitation of a patient's sexual function post stroke.

Trial registration: This cross-sectional study did not require study registration.

Background and purpose: Anticipatory postural adjustments (APA) and compensatory postural adjustments (CPA) have played a vital role in postural control since early childhood, which is critical to accomplishing activities in daily life. However, literature indicated dissimilarities and inconsistencies in APA and CPA analysis in sitting and standing positions in children with Cerebral Palsy (CP). Thus, this study analyzed the changes in postural control (APA and CPA) through the postural muscles [rectus abdominis (RA) and erector spinae (ES)] in both standing and sitting positions during functional activities (grasping a ball) in children with CP.

Methods: Children with CP [N = 21] aged 5-13 years having GMFCS levels I (n = 12) and II (n = 9) participated. Surface electromyography (EMG) was performed for postural muscles (ES and RA) to measure the APA and CPA with two types of loads (heavy and light) in both sitting and standing positions.

Results: Children with CP showed increased EMG amplitude for APA and CPA with a heavier load than light load in sitting and standing positions. The EMG amplitude of CPA in sitting and standing for both load conditions was significantly higher than that of APA.

Discussion: The findings suggest rehabilitation programs should enhance APA and CPA through targeted exercises and load management strategies. These insights have the potential to inform clinical practices, improve postural stability, and ultimately strengthen the ability of children with CP to perform daily activities with greater ease and confidence, thereby significantly impacting the quality of life.

Background: Telemedicine has emerged as an effective approach for managing hypertension, particularly in rural areas where healthcare access is limited. This review evaluates telemedicine's role in providing essential remote healthcare services for hypertension management.

Objective: We determined the effectiveness of telemedicine versus the usual care in hypertension management among adults living in rural settings.

Methods: We conducted a systematic review of randomized controlled trials (RCTs) focusing on adults aged 18 and older with hypertension (blood pressure ≥ 140/90 mmHg) using telehealth services in rural or community-based settings. We searched nine databases, including PubMed, ScienceDirect, and ProQuest, up to April 2024, without restrictions on language or publication year, focusing only on human subjects. Five pairs of reviewers independently screened and selected studies using predefined eligibility criteria. Methodological quality was assessed using the Revised Cochrane Collaboration Risk of Bias tool, and data synthesis was performed using a random-effects model due to study heterogeneity. Evidence quality was evaluated using the GRADE approach.

Results: Nine randomized trials were included. Pooled data showed no clinically significant differences between telehealth and control groups in improving systolic blood pressure (SBP), diastolic blood pressure (DBP), and their changes over time. The mean difference (MD) of SBP in five trials was 0.78 mmHg lower (95% CI: 2.49 lower to 0.94 higher), and the SBP change showed a mean reduction of 2.29 mmHg (95% CI: 4.76 lower to 0.19 higher). DBP in five trials had a mean increase of 0.46 mmHg (95% CI: 0.73 lower to 1.64 higher), and DBP change in six trials showed a mean decrease of 0.83 mmHg (95% CI: 2.34 lower to 0.68 higher). Additionally, telehealth showed varying impacts on BMI and HbA1c levels, with one study reporting a higher BMI increase in the intervention group, while two other studies indicated that mobile health improved HbA1c levels and controlled blood pressure as effectively as standard care.

Limitations: Study heterogeneity, selection, and performance biases, as well as varying healthcare contexts, limited the generalizability of findings.

Conclusion: Telemedicine is as effective as usual care in managing hypertension among adults in rural settings, providing a viable solution for improving healthcare access in these areas. Future research should address biases and explore long-term impacts to optimize telemedicine's effectiveness in diverse populations.

Background and purpose: Goal setting is a key aspect of patient-centered physiotherapy, helping to motivate patients, align healthcare efforts, prevent oversight, and stop ineffective interventions. This study aims to identify facilitators and barriers for physiotherapists in hospitals to set and document patient treatment goals.

Methods: An explanatory sequential mixed-methods approach was used. The survey, informed by systematic reviews of factors influencing shared decision-making and the theoretical domains framework (TDF), included 25 statements to be rated. Two focus groups (n = 8) discussed (1) factors from the survey, (2) the goal-setting processes, and (3) brainstormed facilitators and barriers for documenting physiotherapy goals.

Results: Survey findings showed mixed opinions but agreement on two factors, which indicate that the goal influences the therapeutic interventions and motivates the therapists. The focus group identified four themes: "Goal," "Physiotherapeutic Self-Conception," "Interprofessionality", and "Hospital Setting." Issues included limited space and poor placement in documentation systems, mental rather than written goal conceptualization, and a perceived lack of interest from interprofessional team members, leading to deprioritization by physiotherapists. Finally, joint goal setting was deemed impractical for certain patients.

Discussion: Hospital physiotherapists set treatment goals with their patients. The process is influenced by various factors, including interprofessional dynamics and the hospital setting. The identified themes align with existing literature. Effective documentation of patient-centered physiotherapy goals in hospitals requires well-designed tools and interprofessional collaboration. Further, it is crucial to understand professional self-conception and acknowledge situations where physiotherapists need to set goals independently.

Background: Proprioceptive deficits are common among stroke survivors and can negatively impact their balance and postural control. However, there has been little evaluation of the change in proprioceptive deficits in the lower limbs over time after stroke. This study aimed to examine proprioceptive deficits over time after stroke in both the affected and "unaffected" lower limbs.

Methods: This cross-sectional study included sixty first-time unilateral stroke survivors and twenty age-matched healthy individuals. Participants after stroke were divided into three subgroups based on different time points after stroke. The generally accepted clinical time points after stroke are the first 4 weeks-the acute stage; 5-24 weeks-the subacute stage; over 24 weeks-the chronic stage. The active movement extent discrimination apparatus (AMEDA) was used to quantify ankle proprioception in plantarflexion and inversion directions, on both the affected and "unaffected" sides.

Results: Lower limb proprioception scores decreased linearly over time after stroke on both the affected and "unaffected" sides (p < 0.001). Overall, proprioception scores for the stroke groups were significantly lower than those for the healthy age-matched group (p < 0.01), with the only exception being ankle plantarflexion and inversion scores on the unaffected side in the acute stroke group, which were not significantly different from their healthy counterparts.

Conclusion: Ankle proprioception in both lower limbs decreased over time after a unilateral stroke, with proprioceptive acuity on the "unaffected" side diminishing linearly in the same way as that on the affected side. These observed continuing deficits in lower limb proprioception among stroke survivors raise implications for clinical neurorehabilitation.

Background and purpose: Action Observation Therapy (AOT) has been proposed to improve gait, balance and mobility in subjects with neurological and musculoskeletal disorders. The current review aimed to investigate AOT effects in subjects with gait, balance and mobility impairments.

Methods: A systematic literature search was performed using PubMed/MEDLINE, EMBASE and Scopus databases from inception until May 2023. Randomized controlled trials investigating effects of AOT on gait, balance and mobility in subjects with any type of clinical condition were included. Two reviewers performed data extraction and methodological quality assessment using the revised Cochrane risk of bias tool for randomized trials. The overall effects were reported as mean difference (MD) or standardized mean difference (SMD) with 95% confidence interval (CI).

Results: Thirty-one studies were included. Low evidence supported AOT to enhance walking speed (SMD: 0.40; 95% CI: 0.17, 0.62; I² = 0%), stride length (SMD: 0.35; 95% CI 0.05, 0.66; I² = 0%) and single limb support duration (MD: 4.1%; 95% CI: 1.0, 7.2, I² = 0%) after stroke. Low evidence supported AOT to improve walking distance (MD: 56.8 m; 95% CI; 39.2, 74.4 m) and dynamic (SMD: 0.40; 95% CI: 0.04, 0.76; I² = 0%) and static (SMD: 0.69; 95% CI: 0.32, 1.05; I² = 0%) balance, while very low evidence supported AOT to enhance mobility (MD: -1.48 s; 95% CI; -2.2, -0.8 s; I² = 0%) after stroke. Moderate evidence supported AOT to improve dynamic balance in subjects with Parkinson's disease (SMD: 0.44; 95% CI: 0.09, 0.79; I² = 28%), while low evidence supported AOT to enhance dynamic balance (SMD: 0.61; 95% CI: 0.15, 1.08; I² = 27%) and mobility (MD: -2.08 s; 95% CI; -3.5, -0.6 s; I² = 0%) in patients with orthopedic conditions.

Conclusion: AOT improved gait, balance and mobility after stroke, dynamic balance in patients with Parkinson's disease and dynamic balance and mobility in patients with orthopedic conditions. However, evidence certainty was generally low and further high-quality studies are needed.

Trial registration: PROSPERO International Prospective Register of Systematic Reviews (n. CRD42021240626).

Background and purpose: Children with myopathies often experience muscle weakness in their lower limbs. However, the upper limbs are also affected and, at the same time, play a key role in daily living activities as well as in transfers and assisted mobility using auxiliary devices. The objective was to assess the performance of the elbow flexor and extensor muscles through static and dynamic contractions in children with myopathies and in their typical peers.

Methods: This was a case-control study. Seven children with different myopathies participated and were matched with typical children by sex and age (1:2). The muscle performance of elbow flexors (EFL) and elbow extensors (EEX) was assessed using an isokinetic dynamometer using isometric and isokinetic contractions at a speed of 120°s-¹. The analyzed variables were peak torque (PT), total work (W), power (P), time to peak torque (TPT), acceleration time (AT), and deceleration time (DT). The raw variables were compared between groups using linear regression with mixed effects. A significance level of p < 0.05 was adopted.

Results and discussion: Children with myopathies showed significantly lower values of PT, W, and P for both elbow muscle groups (p < 0.05) compared to typically developing children; TPT showed no difference between groups; and AT and DT were higher in children with myopathies than in typical ones (p < 0.05). Children with myopathies exhibited deficits in muscle performance, suggesting that the elbow muscles adopt atypical motor strategies, indicating impaired neuromuscular control. The isokinetic dynamometer is a device that can provide relevant information about muscle performance in this group of diseases.