Physiotherapy Theory and Practice最新文献

Background: Mechanical traction (MT) is a noninvasive approach to unload the joint in knee osteoarthritis (KOA), however,its effects on co-contraction index (CCI) and balance remain unclear.

Purpose: To investigate whether combining MT with high intensity laser therapy (HILT) yields greater improvements in subjective and objective outcomes among patients with KOA compared to HILT alone.

Methods: Thirty-eight patients with KOA were randomly assigned to MT+HILT (n = 19) or HILT (n = 19) groups and received 10 treatment sessions over 2 weeks. Outcomes included pain (VAS), function (WOMAC), active knee flexion range of motion (AROM), CCI, and balance during curve tracking (CT) and sit-to-stand (STS) tasks. A two-way mixed-model ANOVA was used to assess the effects of treatment and time (pre - post).

Results: The MT+HILT showed significantly greater improvements than HILT in VAS (p < .001, η_p² = 0.27), WOMAC (p < .001, η_p² = 0.37), and AROM (p < .001, η_p² = 0.12). During CT, MT+HILT significantly reduced anteroposterior and mediolateral mean absolute errors (p = .00 and 0.03, η_p² = 0.10 and 0.15), and standard deviations of absolute errors (p = .02 and 0.04, η_p² = 0.82 and 0.15). Center of pressure area also decreased significantly in anteroposterior and mediolateral directions (p = .03 and 0.01; η_p² = 0.66 and 0.23).

Conclusion: These findings suggest that the combined application of MT+HILT may serve as an effective conservative strategy to improve pain management, functional capacity, AROM, and balance, potentially contributing to a reduced risk of falls in individuals with KOA.

Background: Functional constipation (FC) is a common condition that includes difficult, irregular bowel movements, abdominal pain, and bloating.

Purpose: To investigate the comparative effectiveness of connective tissue manipulation (CTM) and interferential currents (IFCs) over behavioral education and therapy (BET) on FC.

Methods: Fifty-four patients with FC were randomly assigned into four groups. The control group received only BET, the intervention groups received CTM, IFC_0-100, or IFC₁₀₀ additional to the BET, 3 days/week for 4 weeks. CTM was initially applied to the lumbosacral area; in subsequent sessions, the lower thoracic, scapular, interscapular, and cervical regions were also included, respectively. Bowel function (7-day-bowel diary), constipation severity (Constipation Severity Instrument), and QoL (Patient Assessment of Constipation Quality of Life) were assessed at baseline, after interventions, and at the end of the 1-month follow-up. Treatment satisfaction was assessed with visual analog scales.

Results: The defecation frequency increased and the defecation duration per attempt decreased in all groups (p < .05). In the CTM, IFC_0-100 and IFC₁₀₀ groups, defecation frequency increased more than in the control group (u = 23.500, u = 26.500, u = 15.500, respectively), (p < .001). The constipation severity decreased (p < .05), and this effect was maintained in all groups at the follow-up period (p > .05). QoL improved in all groups after the interventions, and was higher in the IFC_0-100 [95% CI=(-15.91-(-2.09)], and IFC₁₀₀ [95% CI=(-13.99-(-0.17)], (p < .05) groups than control group at follow-up, with no significant difference between control and CTM groups (p > .05). Treatment satisfaction was significantly higher in CTM [95% CI=(-1.3557-(-0.3443)], IFC_0-100 [95% CI=(-1.6911-(-0.6605)], and IFC₁₀₀ [95% CI=(-1.5450-(-0.5144)] groups than control group.

Conclusion: Additional CTM or IFCs to BET provide significant and long-lasting (at least 1 month) contributions to the bowel functions, QoL, and increase treatment satisfaction in patients with FC.

Background: Pharmacological treatments have been shown to improve physical and physiological functions in patients with axial spondyloarthritis (axSpA).

Purpose: This study aimed to compare core endurance, exercise capacity, cardiopulmonary responses during exercise testing, quality of life (QoL), and disease activity among patients with axSpA using biological and non-biological treatments, and healthy controls.

Methods: This cross-sectional study involved 52 patients on biological therapy, 57 on non-biological drugs, and 46 healthy controls. Core endurance (McGill tests), exercise capacity (six-minute stepper test), and disease activity indexes (The Bath Ankylosing Spondylitis Disease Indices; BASDAI, BASMI, BASFI, ASDAS-CRP, Leeds Enthesitis Index; LEI), spinal and hip radiographic scores (modified Stoke Ankylosing Spondylitis Spinal Score; mSASSS), Bath Ankylosing Spondylitis Radiology Hip Index; BASRI-hip), pain (Numeric Rating Scale), patient and physician global assessments, cardiopulmonary responses, quadriceps muscle fatigue and dyspnea (Modified Borg scale), laboratory markers (CRP, ESR), and QoL (Ankylosing Spondylitis QoL Scale; ASQoL) were measured.

Results: Step counts in the six-minute stepper test, trunk flexor, and lateral flexor muscle endurance values were significantly lower, while fatigue and quadriceps muscle fatigue during the six-minute stepper test were significantly higher in patients compared to healthy controls (p < .05). BASMI values were significantly lower in the non-biological treatment group compared to the biological group (p < .05). Step counts showed weak correlation with BASMI (r = -0.142; p = .167), moderate-strong correlation with BASDAI (r = -0.458; p < .001), ASQoL (r = -0.450; p < .001), ASDAS-CRP (r = -0.361; p < .001), trunk extensor and flexor muscle endurance (r = 0.489; p < .001, r = 0.485; p < .001), right and left trunk lateral flexor muscle endurance (r = 0.584; p < .001, r = 0.572; p < .001), and BASFI (r = -0.582; p < .001). Step count variance was explained by BASMI, BASDAI, BASFI, ASQoL, and trunk endurance, accounting for 34.1% of the total variance.

Conclusion: These findings may assist clinicians in planning personalized rehabilitation programs by considering not only functional limitations but also treatment history of the patients with axSpA. Understanding the effects of pharmacological treatment history on exercise capacity and core muscle endurance may guide the development of more effective physiotherapy approaches.

Objective: This study investigated changes in ankle function in older adults with a history of falls and the influence of gender. It also explored the relationship between balance and ankle function in fallers.

Methods: A cross-sectional study of 78 nursing home residents [54 women (mean age: 75.54 ± 4.88), 24 men (mean age: 78.87 ± 5.50)] aged ≥65 years was conducted. Ankle dorsi-plantar flexion range of motion (ROM), tibialis anterior (TA) and gastrocnemius (GC) electromyography (EMG) activity during contraction/relaxation, and isometric TA/GC strength were measured. Fear of falling (FoF) and balance were assessed using the Falls Efficacy Scale (FES) and Berg Balance Scale (BBS), respectively.

Results: Rates of fallers (women %32, men %33) were similar between genders. Men with a history of falls showed higher GC EMG activity (p = .016) and greater FoF (p = .016) than women with fall history. Fallers versus non-fallers in men also exhibited higher GC EMG activity (p = .039) and FoF (p = .011). In men, fall number positively correlated with GC work average and FES. A strong negative correlation existed between BBS and FES in male fallers (r = -0.985, p = .015).

Conclusion: Ankle ROM and muscle function may be unaffected in women post-fall. However, men experiencing falls might have reduced ankle strength, potentially compensated by increased EMG activity. Men appear more significantly impacted by falls psychologically and functionally.

Background: Females have worse functional outcomes than males after a stroke including worse standing balance, slower gait speed, and higher fatigue levels. The current understanding of stroke recovery mechanisms has not yet been able to explain why females have worse outcomes compared to males. Functional Near Infrared Spectroscopy (fNIRS) amplitude offers information on the level of cognitive effort required to perform a task, as well as the impact of rehabilitation on brain function.

Objectives: The aim of this case series was to use fNIRS to provide detailed prefrontal cortex activation data on several functional lower extremity sensorimotor tasks in females admitted to a stroke inpatient rehabilitation unit.

Methods: Four female participants completed impairment, balance, gait, and fatigue measures as well as fNIRS assessments at admission and discharge from the inpatient stroke rehabilitation unit. fNIRS assessments included quiet and semi-tandem standing, and supine ankle sensorimotor tasks.

Results: All participants had a subcortical ischemic stroke with improvements in sensorimotor impairment (average 9-point increase on the Fugl-Meyer), balance (average 29-point increase on the Berg Balance Scale), and gait (average 0.25 m/s increase in gait speed, average 30 m increased distance on the 2-minute walk test) at discharge. Larger fNIRS amplitudes were observed at baseline which were reduced at discharge for the three supine tasks, and these changes were less evident for the two standing tasks. Two females had decreased fatigue at discharge with the other two females experiencing small increases (average 0.5-point decrease on the Fatigue Severity Scale).

Conclusions: For females admitted to an inpatient stroke unit, relationships may be present with improvements on clinical scores and decreased fNIRS amplitude during supine tasks, with standing tasks generating more diverse fNIRS responses. These findings suggest that fNIRS can provide prefrontal cortex activation data in females on an inpatient stroke unit and that a standard inpatient rehabilitation program appears to have an effect on fNIRS amplitudes.

Background: Canalith jam (CJ) is a rare variant of benign paroxysmal positional vertigo (BPPV), resulting from otoconial obstruction of endolymph flow. It causes persistent, direction-fixed nystagmus (DFN) and can mimic acute vestibular syndrome (AVS), including vestibular neuritis (VN) or stroke.

Objective: To describe the clinical and infrared video-Frenzel (IRVF) based diagnosis of horizontal semicircular canal (HSC) canalith jam (HSCCJ), a subtype of CJ, and to highlight the role of physiotherapy-guided bedside maneuvers in its successful management.

Case descriptions: Three patients (aged 50, 55, and 62) presented with positionally triggered acute vertigo. Patients 1 and 3 had sustained DFN consistent with AVS, whereas patient 2 developed persistent DFN during positional testing. The diagnosis of HSCCJ was established through positional tests [supine roll test (SRT), bow and lean test (BLT)] and assessment of DFN using IRVF goggles.

Intervention: All patients underwent a physiotherapist-administered head-shaking maneuver (HSM) in the yaw plane, performed with 30° of neck flexion. One patient also received the Gufoni maneuver (GM). Maneuvers were guided by real-time oculomotor responses recorded via videonystagmoscopy.

Outcomes: All patients experienced complete resolution of symptoms and nystagmus within 4 hours, confirmed by repeat testing at 4 and 24 hours. Transient nausea and vomiting were the only adverse effects observed.

Conclusion: Although the diagnosis of HSCCJ depends on clinical and oculographic evaluation, physiotherapy-guided HSM is a simple, safe, and effective bedside intervention. Incorporating this approach into vestibular rehabilitation (VR) protocols may enhance outcomes in atypical BPPV.

Introduction: Chronic ankle instability (CAI) is associated with altered gait mechanics and cognitive-motor deficits, while some individuals with a history of ankle sprain recover successfully as copers. Dual-tasking and fatigue represent common real-world challenges, but their combined effects on gait in CAI compared with copers remain unclear.

Purpose: To investigate the effects of motor fatigue on spatiotemporal gait parameters under single- and dual-task conditions in individuals with CAI compared with copers.

Methods: Thirty individuals with CAI (mean age 26.7 ± 7.2 years) and 30 age- and sex-matched copers, (mean age 24.48 ± 6.2 years) completed gait trials under single- and cognitive dual-task conditions, both before and after a fatiguing exercise protocol. Spatiotemporal gait parameters were recorded, and repeated-measures ANOVA with Bonferroni correction was used to examine main effects and interactions.

Results: Dual-tasking significantly altered gait in both groups, with increased step length (p = .005) and step time (p < .001) and reduced step width (p = .018) and step length variability compared with single-task walking (p = .036). Fatigue further modified spatiotemporal parameters. The individuals with CAI showed increased variability in step length, while copers demonstrated decreased variability in step time (p = .021). Cognitive performance remained stable across conditions.

Conclusion: Dual-tasking and fatigue interact to shape gait differently in CAI and coper groups. Rather than uniformly impairing gait, dual-tasking sometimes promoted more consistent walking, while fatigue destabilized gait, particularly in individuals with CAI. These findings highlight the importance of incorporating both cognitive and fatigue-related challenges into rehabilitation to better prepare individuals with CAI for real-world demands.

Introduction: Chronic kidney disease (CKD) is associated with muscular and respiratory complications, negatively affecting respiratory muscle strength, pulmonary capacity, peripheral muscle strength, and functional capacity in patients undergoing hemodialysis (HD). Understanding the extent of these impairments is essential to guide therapeutic strategies.

Objective: To evaluate the impact of CKD on respiratory muscle strength, pulmonary capacity, peripheral muscle strength, and functional capacity in patients undergoing dialysis.

Methods: This systematic review was conducted using PubMed/MEDLINE, LILACS, Embase, SciELO, and the Cochrane Library, with searches performed from July to August 2025. Cross-sectional observational studies evaluating respiratory muscle strength, pulmonary function, peripheral muscle strength, and functional capacity, compared with predicted values for sex and age, were included. Methodological quality was assessed using the Newcastle - Ottawa Scale. Results: A total of 1266 articles were identified, of which 22 met the inclusion criteria. Most studies presented satisfactory methodological quality (scores ≥6). Patients with CKD undergoing hemodialysis exhibited reduced respiratory muscle strength, with mean maximal inspiratory pressure of 53.7 ± 19.5% and maximal expiratory pressure of 49.5 ± 15.8% of predicted values. A moderate to strong correlation between maximal inspiratory pressure and functional capacity was observed (r = 0.38-0.79). Handgrip strength was also reduced compared with healthy individuals, with values approximately 40% below normal (28.18 ± 9.36 kgf; 114.00 ± 39.51% of predicted). Functional capacity was impaired, as indicated by a six-minute walk test distance corresponding to 66.33 ± 20.53% of predicted values. Pulmonary function findings were heterogeneous, with restrictive ventilatory pattern being the most frequently reported abnormality (66.7%). Conclusion: Patients with CKD undergoing hemodialysis present reduced respiratory and peripheral muscle strength, pulmonary capacity, and functional capacity.

Purpose: This study aimed to compare the short-term clinical and economic outcomes of physiotherapy, pharmacological therapy, and combined management in patients presenting to the emergency department (ED) with acute mechanical low back spasm.

Methods: A retrospective analysis was conducted on 150 adults aged 18 to 65 years who presented to the ED between January 2024 and January 2025. Patients were retrospectively stratified according to the treatment received during routine emergency care into physiotherapy, pharmacological therapy, or combined therapy groups (n = 50 each). Pain intensity and functional activity were assessed at baseline (pre-treatment) and post-treatment at ED discharge, and direct, short-term costs related to ED care were calculated.

Results: All treatment groups demonstrated significant reductions in pain intensity after intervention (within-group p < .001). The combined therapy group showed the greatest pain reduction (ΔVAS -5.80 ± 1.42), compared with physiotherapy (-3.80 ± 1.70) and pharmacological therapy (-3.30 ± 1.84) (between-group p < .001), with a large effect size (ε² = 0.31). Functional activity improved significantly in all groups (p < .001), with no significant difference between treatment modalities (p = .843). Patient-reported satisfaction scores differed significantly among groups and were highest in the combined therapy group (p < .001). Total treatment cost varied significantly between groups (p < .001), with pharmacological therapy being the least costly option.

Conclusion: Combined physiotherapy and pharmacological treatment was associated with superior short-term pain relief and higher patient-reported satisfaction compared with either approach alone in patients presenting to the ED with acute low back spasm. Despite higher immediate costs, these findings support the integration of physiotherapy into emergency care to improve short-term, patient-centered outcomes. Further prospective and cost-effectiveness studies are warranted.

Clinical trial registration: ClinicalTrials.gov Identifier: NCT06987656.